Will Health Care Reform Help Those Most at Risk? A Unique Perspective from the NAMI Crisis Intervention Team (CIT) Action Center

by Laura Usher, NAMI CIT Coordinator

Laura Usher, NAMI Crisis Intervention Team (CIT) Coordinator

Since the passage of health care reform legislation earlier this year, most Americans are still trying to understand what the new law will mean for them. Regardless of your personal opinion on health care reform overall, it is important to gain some understanding of what the law might mean as we look ahead  knowing that the implementation of many parts of the law are not clear.

A few of the provisions have gone into effect this fall, but the majority of reforms won’t be implemented until 2014. Here at NAMI, we have been asking, will health care reform help some of our most vulnerable members—those who are at risk of involvement with the criminal justice system?

The reforms are not likely to have an effect on individuals currently in jail or prison; these individuals are considered exempt from the health care reform law. People who are incarcerated have a limited right to health and mental health care protected by the Constitution.

This is important to NAMI because more than 450,000 Americans with a recent history of mental illness are incarcerated in U.S. jails and prisons. In one study, 28 percent of people with serious mental illness were arrested at least one time in a 10-year period. The majority of these arrests were for non-violent crimes like crimes against the public order or a property offense.

Thus, even a minor offense can change the course of person’s life:  a criminal record means more trouble getting housing or services, more likelihood of experiencing violence or trauma as well as estrangement from family and community supports. For many, this tragic situation begins because they do not have access to quality treatment and services. Health care reform may improve access to care for people living with mental illness, breaking the cycle of incarceration for those re-entering society or preventing it from starting for those who are at risk of encountering the police. The new law will provide access to health care for many who desperately need it—by 2014, approximately 94 percent of Americans will have some kind of health insurance coverage. It is hoped that the improved access will translate into improved services for people living with mental illness, many of whom currently go without the treatment and services they need.

Coverage expansion comes in a variety of forms—increased funding for Medicaid and Children’s Health Insurance Program (CHIP) programs; stricter rules for private insurance which will prevent them denying coverage based on pre-existing conditions or cancelling coverage due to illness as well as subsidies for low-income people to help them buy coverage in state-regulated exchanges.

We also know that there will be a required benefits package, which will include basic mental health and substance abuse treatment, for all Medicaid and private insurance plans.

In addition to increased access, the health reform law offers some opportunities for integration of primary care, mental health and substance abuse treatment— which we know is important, since most people living with mental illness in the criminal justice system also have co-occurring disorders. However, this push towards integration will not help everyone— states will have an option to include it in their Medicaid programs in addition to a new federal grant program to allow community mental health centers to locate primary and specialty care services in the same facility.

Are improved access to care and limited integration of care enough to help people with serious mental illness stay out of the criminal justice system?  I am hopeful that, for many individuals, they will be. But we know that people living with mental illness who are involved with the justice system face a variety of challenges. For example, a high percentage lives with a co-occurring substance use disorder.

We know that involvement with the justice system often starts early in life, with more than two-thirds of children in the juvenile justice system having at least one diagnosable mental disorder. The intersection of mental illness and the justice system can exacerbate an individual’s problems on many levels. People who are incarcerated and live with mental illness tend to experience higher rates of sexual and physical abuse and unemployment than other inmates.

We also know that people living with mental illness who are involved with the justice system often get trapped in cycles of crisis, alternating between jails, homelessness, shelters and emergency rooms. Once someone has been in jail, he or she often has trouble connecting or reconnecting with life-saving services like income supports, Medicaid and housing.

I think the health care reform law will be good for some people; for many people access to care will be life-changing. But we will need to continue to advocate for a variety of services and supports—such as Assertive Community Treatment (ACT), supportive housing, employment and education assistance—to help people achieve the recovery needed to stay out of the justice system. And since many people living with mental illness are already entangled with the justice system, we will need to continue to fight for cross-system collaborations like crisis intervention teams (CIT) that bring together mental health systems, criminal justice systems and advocates to find creative solutions.

Finally, NAMI State Organizations and NAMI Affiliates will need to stay engaged to shape how health care reform is implemented. Major decisions about the content of benefits packages and other important issues are still on the table, and our voices must be heard to ensure that people living with mental illness get the comprehensive services and supports they need.

What do you think? Will access to health care help you or your loved one who is at risk stay out of jail? Or do you think that the challenges facing people who at risk of involvement with the justice system are too great?

As NAMI develops more resources to assist advocates, you can find them on our website at: www.nami.org/healthcare.Fact sheets are also available and offer a general overview of the health care reform legislation. Learn more about NAMI’s CIT Action Center or NAMI’s efforts to address criminalization and people living with mental illness.

NAMI Connection: Strength from Shared Experience

by Candita Sabavala, director, NAMI Connection Recovery Support Group Program

The NAMI Connection vision and the importance of peer support

Candita Sabavala Director, NAMI Connection Recovery Support Group Program

“We embrace humor as healthy.” “We forgive ourselves and reject guilt.” “We will never give up hope.” These are very important messages for people living with mental illness, messages that they need to hear. These three concepts are some of the principles of support behind the NAMI Connection Recovery Support Group Program, which fits peer support, that crucial piece of the recovery puzzle, into individuals’ lives.

Peer support is essential in helping people living with mental illness realize they are not alone; that someone else understands what they are going through and are ready to help by offering insight from their own experience. Research has shown that participation in peer support programs is beneficial to the individual, causing recognizable improvement in psychiatric symptoms and decreased hospitalization, the expansion larger social support networks, enhanced self-esteem and social functioning while decreasing the lengths of hospital stays and the overall cost of treatment.

We find strength in sharing experiences: The NAMI Connection model

NAMI recognizes the importance of peer support for people who live with mental illness and responds to this need with NAMI Connection. NAMI Connection is a free, weekly, 90-minute support group for any person with a mental illness available in hundreds of communities across the country. The NAMI Connection model works so effectively because it is run by facilitators who are in recovery themselves. The group can talk about personal situations and both give and receive guidance. For some participants, realizing that their experiences can help them help others is a first step in rebuilding their self esteem which has been shaken by the illness experience.

From California to Connecticut, each group makes its own way through the same set of principles and practices. One of the unique things about the model is that it acts on multiple levels: a 2008 survey of NAMI Connection participants showed that group members found both understanding and practical information to help with problems.

We understand that mental illnesses are traumatic events: Empowerment and community

When people first come to a NAMI Connection support group, they often feel isolated, discouraged and even hopeless. The experience of mental illness often brings with it multiple losses—the loss of a job, relationships and other things one can expect from life. Each of these losses can take a toll on individuals’ self-concept, making them less likely to take social risks, which in turn keeps them from taking steps towards recovery. NAMI Connection provides a way out of this cycle with a safe environment for people to emerge from isolation and form bonds, make new friends, and experience a sense of acceptance and belonging.

Many people write to us about their experience in a NAMI Connection group and tell us how much the group process has helped them. One person relates,

“I am not alone! There is a place where people understand me, are there to help me, and I feel better about myself when I help someone else. I can get involved in NAMI Connection and make a difference!”

After attending several groups, many people feel they are getting so much out of the experience that they would like to be trained as a facilitator and guide a group themselves. Facilitators then have the option to become trainers, and many also start volunteering in other capacities for their NAMI State Organization or NAMI Affiliate. Many then feel ready to entertain the idea of part-time or full-time work. One group attendee tells us,

“The NAMI Connection group is the best one because people can solve problems there. It isn't just a bunch of sad stories; people are coming up with solutions and stuff to do for the next week. One of our group attendees is taking her meds, getting herself to her counselor and is just about able to go back to her career—in great part due to NAMI Connection.”

We expect a better future: Making new Connections

Since NAMI Connection launched in 2007, we have established more than five hundred groups in forty-seven states with our NAMI Affiliates. As part of our effort to reach out to diverse communities, we launched the Spanish-language NAMI Conexiòn this fall to address the needs of the Latino community, and we are currently developing initiatives to reach veterans as well as people living with mental illness in jails and prisons.

The program is also stepping up its web offerings, including a Facebook Community and an online Skype group currently in beta testing. We are very excited about this project, as it makes the group accessible to a whole new community of participants in rural areas and those without reliable transportation.

We want to make this life-changing program available to as many people as possible—to make a support group available every day of the week for anyone, no matter where they live, who needs the strength they can find in sharing experiences.

Veterans Day: NAMI Extends Our Gratitude

This week marks the time of year when we as a nation turn our attention to those among us whose service to  our country—past and present—and we seek a way to demonstrate our appreciation to them for their commitment.

Veterans Day is a holiday that compels us all to go to a place of respect for the hard truths and hard times inherent in military service—what our veterans understand with the deep wisdom of experience.
Many veterans have left one battle behind only to encounter another at home and work. Recent studies tell us that nearly a third of veterans who seek care through Veterans Administration (VA) health centers receive mental health diagnoses.

Among the barriers encountered, stigma remains as a huge obstacle. Not only is the high suicide rate among active-duty troops and veterans of great concern to all branches of the military and to us, many of those currently serving are reluctant to even mention symptoms of mental illness, fearing that seeking treatment may affect their careers. A survey of troops in Iraq and Afghanistan found that of those whose responses met the criteria of a mental illness, only 38 to 45 percent expressed an interest in receiving help.

So, what can we do at NAMI? How can we help? What can we do to help our veterans and their families find help, relief, support and a promise of recovery?

Our online Veterans Resources Center consolidates the most useful online resources for veterans and their families. It also addresses the needs of active duty military contending with posttraumatic stress and other mental health issues. The NAMI HelpLine responds to calls from individuals and families alike searching for a sympathetic listener, resources and referrals to services and support. We offer family education course to military families through the NAMI Family-to-Family collaborative with the Veterans Health Administration in communities across the country. And, guided by our volunteer leadership and advisory council, the NAMI Veterans Council, we engage in public policy advocacy at all levels to ensure that veterans and their families have access to the health care services and supports they need.

And yet, there are more people—active duty, veterans and their family members—who need help and hope. At NAMI, we acknowledge both veterans’ service to our country and the hidden wounds many carry as a result. We invite you to join us in this effort by extending your support via a post to our Veterans Tribute Honor Roll.

In the words of John F. Kennedy, “As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.” This week, we remember so that we won’t forget.

What Do This Week’s Election Results Mean For People Affected By Mental Illness

Andrew Sperling, Director of Legislative Advocacy

by Andrew Sperling, Director of Legislative Advocacy

While the political pundits and partisan spinmeisters are still busy on television and on-line analyzing the 2010 election results, a few certainties are starting to emerge regarding how the repercussions this may play out in 2011 and beyond for people living with mental illness and their families. While the impact is far from certain, we can predict with some precision what the shift of partisan control in Congress will mean–both in terms of the Republicans taking over the House and the Democratic majority in the Senate being significantly reduced.

A few things we anticipate include:

Discretionary Spending Will Remain Flat in 2011 and 2012

At minimum, the Obama Administration is expected to come forward with a flat budget proposal for fiscal year 2012 in February–with exceptions made for defense and veterans. The new House Republican majority is likely to go even further and seek to cut domestic discretionary programs back to fiscal year 2008 levels. This could mean as much as a 7 percent reduction for mental illness research at the National Institute of Mental Health–from $1.541 billion, down to $1.405 billion–ASSUMING the President relents and accepts cuts of this level to domestic spending.

The Increase in Federal Medicaid Payments (FMAP) Will Not Be Extended

In light of revenue shortfalls in almost all of the states, the federal government provided a temporary increase in the Federal share of Medicaid spending. which was scheduled to end on December 31, 2010 and extended until June 30, 2011, albeit at a reduced rate. The combination of concern over federal spending  with the changes in Congress would suggest that chances of extending this federal support to states is unlikely to be extended again. Not a single House Republican voted for the higher FMAP last summer, so there is little expectation that the new majority would be supportive of extending higher FMAP any further in 2011.

It will be Difficult to Repeal Healthcare Reform

The political realities of repealing a law make this scenario very unlikely, principally because of President Obama's veto power. Another complication is that some parts of health care reform already in effect are pretty popular. Among them are provisions forcing insurers to cover children with pre-existing conditions and allowing parents to keep kids up to age 26 on their policies. That's why you hear so many pundits asserting that any potential rollbacks would be more piecemeal rather than a full-scale discard.

While we will likely see many proposals related to changing the healthcare reform law, most concerning for NAMI and people with mental illness will be efforts to scale back or delay the Medicaid expansion scheduled for 2014. As noted above, federal discretionary funding will not be growing and additional federal Medicaid assistance is unlikely. The consequences of these actions will put further pressure on state and county budgets, further eroding resources for publicly funded mental health services which are critical for many people who live with mental illness.

A more thorough analysis of what the election results might mean for people with mental illness will be published in the November edition of the NAMI e-Advocate. To subscribe, sign up for this monthly e-newsletter.

A Gracious NPR Reply

by Michael J. Fitzpatrick, Executive Director

In the best of all worlds, blogs help build community. Last week, our blog discussion was part of broader communication that helped worked through some difficult issues involving the recent NPR controversy.

Following up on my last entry, I want to share (below) the reply of NPR president & CEO Vivian Schiller to NAMI’s letter. We also talked by phone. Ms. Schiller fully understands NAMI’s concerns. She extended a sincere apology. I accepted it on behalf of all NAMI members and others who contacted us.

I also want to note that NPR’s reply is one of the swiftest, most straightforward responses NAMI has ever had to a stigma concern. That’s consistent with the NPR that we have long known to be fair and compassionate in its reporting on mental illness.

October 28, 2010

Michael J. Fitzpatrick
Executive Director
National Alliance on Mental Illness
3803 North Fairfax Drive, Suite 100
Arlington, VA 22203-1701

Dear Mr. Fitzpatrick:

Thank you for your letter dated October 26.1 appreciate you taking the time to share your concerns with me.

I have great compassion and respect for those who live with mental illness,
and tremendous regard for the mental health professionals and organizations
such as NAMl who serve and advocate on their behalf.

I believe that consulting a mental health professional should be as
unremarkable as seeing any other health care professional.

I deeply regret my unintentionally hurtful remark. Please extend my heartfelt
apology to those individuals and families who battle against the undeserved
stigma of mental illness everyday.

Thank you again for sharing your thoughts.

Sincerely,

Vivian Schiller
President and CEO