True or False: Three out of four patients with schizophrenia report substance use. 

True!

A review of electronic medical records of patients with schizophrenia spectrum disorders in a community teaching hospital’s psychiatric unit found that more than three-quarters used substances such as tobacco and cannabis. Researchers presented their findings in a poster at the virtual 2021 American Psychiatric Association Annual Meeting.

Among patients with schizophrenia, 62.3% used tobacco, 41.5% used cannabis, 40.2% used alcohol, and 27.4% used cocaine. In patients who reported using tobacco, unadjusted odds ratios were 7.24 for comorbid alcohol use, 5.00 for cocaine use, 4.62 for synthetic cannabis use, and 2.80 for cannabis use, according to the study. Multivariate analysis results supported the findings.

Posted on 6/17/2021 Quiz: Do Three Quarters of Patients with Schizophrenia Report Substance Use? (hmpgloballearningnetwork.com)

With that information, one would hope that the behavioral health providers would do a better job at treating dual diagnosis individuals. Often families of loved ones that have serious mental illness and substance use disorders hear that the person needs to get sober before mental health treatment can be effective. However, they are also then told that the person is too ill to be in the substance use treatment because of their serious mental illness. Kind of a Catch 22 situation. Treatment needs to address both illnesses.

This report identifies all of the dialogue with respect to the need for coalitions regarding behavioral health. 

Jim McDougall

ACMI Board Member


State Courts’ Responsibility to Convene, Collaborate, and Identify Individuals Across Systems

Issued September 25, 2023 in NCSC Trends in State Courts

By Jacquelyn Gilbreath
Court Research Analyst, National Center for State Courts
Susanne Mitchell
Court Research Associate, National Center for State Courts
Nicole L. Waters
Director, Research Services, National Center for State Courts

Collaborative efforts among justice, mental-health, and public-health systems are essential to respond to individuals who frequently cycle through systems. Court leaders are well positioned to convene stakeholders to implement effective responses to reduce the negative impacts on the nation’s courts.

*Promising practices included in this article were informed by interviews with jurisdictions in six states, as well as from workshops and webinars highlighting current efforts in responding to the needs of individuals with serious mental illnesses (SMIs) and substance use disorders (SUDs) in their jurisdictions.

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TRENDS IN STATE COURTS
State Courts’ Responsibility to Convene, Collaborate, and Identify Individuals Across Systems Who Frequently Cycles Through Systems?
Across the country, there have been systemic failures in how communities and the justice system respond to those with serious mental illness (SMI), creating a revolving door through which vulnerable individuals cycle continuously (Fuller, Sinclair, and Snook, 2017).
Examples include rigid legal standards for involuntary commitment (Conference of Chief Justices, 2006) and gaps in competency evaluation and restoration services, producing unethical delays that have led to litigation against various government entities across the United States (Fuller et al., 2017). Community members who cycle through jails, hospitals, mental- and behavioral health facilities, and other social-service programs strain community resources (National Association of Counties, 2016). In Miami-Dade County, Florida, deplorable conditions for those with SMI involved in the justice system led the Honorable Steve Leifman to work with community stakeholders to implement solutions through the Eleventh Judicial Circuit Criminal Mental Health Project (for more information, see https://tinyurl.com/snuess7). Data-collection and data-matching efforts there showed that 97 high service- utilizing-individuals with SMI cost taxpayers $13 million in criminal justice costs over a five-year period (Mental Health Institute, 2010).
The health-care field has offered early efforts to identify individuals who cycle through various social systems, focusing primarily on medical services and emergency departments. However, research has indicated that community leaders overlook the role of SMI when examining frequent utilization of services (Fuller, Sinclair, and Snook, 2017). The intersection of SMI and the justice system has brought the issue of frequent utilization to the forefront for many judges and jurisdictions. To examine the issue, some jurisdictions focus on frequent utilization of multiple
social systems within their jurisdiction. Examining data from multiple sources, such as behavioral-health services, homeless services, and jail or court records, creates a robust profile of individuals cycling through these systems. While many jurisdictions focus mainly on the criminal justice system (CJS), there are civil justice issues as well, including involuntary civil commitments or orders for assisted outpatient treatment (AOT). Initiatives to share and examine data to identify and respond to frequent utilization begin for various reasons but should center on better serving
individuals who cycle through various social systems.
The figure below depicts the Sequential Intercept Model (SIM; available at https://www.prainc.com/sim/) and additional areas of focus, a conceptual model to inform community-based responses to system use by individuals with SMI, substance use disorders (SUDs), or both.
This model highlights points of contact as intercepts, which are intervention points to keep an individual from further penetrating the CJS.
The Sequential Intercept Model (SIM) and Additional Areas of Focus for Coordinated Court and Community Responses. http://apps.ncsc.org/MHBB

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Managing Frequent Utilization Through Data
Data and information sharing span all the SIM intercepts, which inform a range of efforts, including pre- or post booking
diversion, services provided in custody, creative sentencing options, and reentry efforts emphasizing referrals and warm handoffs to community-based services. The ways in which communities define and identify an individual who cycles through various social systems vary greatly and often relate to which entity is inquiring about utilization. For example, jurisdictions may define this population as the top 100, or 5 to 10 percent of individuals who utilize services the most, or those who were arrested more than four times in 12 months. The first step is for the community to agree upon the criteria for identification. The community should regularly reevaluate these criteria to ensure relevance to the shifts in the population served across mental- and public-health systems over time.
Screening for SMI and SUDs in the custody of law enforcement is a best practice to identify individual needs and provide appropriate services. Data-sharing and data-matching efforts between jails and community based behavioral-health providers are useful in coordinating and providing continuity of care when individuals are in custody and upon their release into the community. Ultimately, these efforts can facilitate a move upstream to incorporate proactive approaches offering outreach and providing services, rather than reactive responses, after a crisis or an interaction with the CJS. Some examples of efforts to address the needs of individuals who cycle through various services are outlined below:

  • Lake County, Illinois identifies frequent utilizes of the jail (individuals who were booked three or more times over 12 months), screens for SMI, and connects individuals to community service providers for intensive case management and to a peer specialist, who assists with individual needs.
  • Fairfax County, Virginia examines 9-1-1 and call-for-service data to identify which individuals use first-responder systems the most and to
    identify individuals who can be provided with community outreach, including a peer specialist on the outreach team.
  • Johnson County, Kansas uses outreach efforts and referrals based on screenings conducted at the jail, as well as previous use of county services. Additionally, a collaboration with Carnegie Mellon University uses predictive analytics to determine which individuals may have an adverse interaction with law enforcement. This list is sent to the mental health center every month for outreach efforts.

60

What Is the Role of the Courts?
While the Conference of Chief Justices passed a resolution in 2006 outlining the need for court leadership to address the impact of mental illness on the court system, much work still needs to be done. A recent policy paper from the Conference of State Court Administrators calls on judges to collaborate within their communities, engage with policymakers to correct problems, and develop better tools for addressing mental-health issues (Mack, 2016).
Be advocates and leaders of change:
Judges are in a unique position to gather stakeholders and facilitate cross-system change.

A common notion expressed across jurisdictions was that addressing frequent utilization would not be possible without the support of judicial leadership and, in some cases, the initiation of change efforts by judges. Court leaders have a responsibility to reduce the reach of the CJS to individuals with SMI, SUD, and co-occurring disorders (CODs).
The National Center for State Courts (NCSC) has created a national guide (2019) to help judges and judicial officers cultivate community change in addressing mental-health issues. The national guide lays out steps for beginning the movement toward change in the court and community’s
response to mental health and CODs, by inviting stakeholders (see table below) to participate in commencing and sustaining responses for long-term impact. An additional NCSC resource is the “Data Governance Policy Guide” (Robinson and Gibson, 2019), which provides guidance for courts on how to convene stakeholders to discuss storing, sharing, and managing data.

61
Recognize opportunities for growth and improvement:
While no jurisdiction wants a systematic failure to be publicly highlighted in their community, these events provide an opportunity to reexamine how various systems address the needs of vulnerable community members.
Communities that identify individuals who cycle through various social systems and target responses across the justice system not only can stop a vicious cycle for individuals and affected families, but also save resources significantly across these systems.
Be receptive to innovation and change:
Court leaders should embrace data, listen to stakeholders who outline issues that may need to be addressed, and be open to the interpretation of data that uncovers issues. Data, information from programs and stakeholders, and feedback loops should spur innovation. Court leaders
should empower system actors to innovate, rather than become embattled in adversarial approaches. For example, in Milwaukee County, judges received trauma-informed training as part of their dedication to determine better solutions to serve justice-involved individuals with mental illness. Court leaders should use data strategically to effect meaningful change.
Court leaders can begin by tracking and extracting data to enable the community to understand the current system within their jurisdiction. An example of innovation is the Jail Diversion Program in Miami-Dade County, where individuals are diverted from the justice system into treatment, and their legal charges may be dismissed in accordance with treatment engagement. These approaches not only provide connections to services but also reduce the negative impact of the justice system on those suffering from SMIs, SUDs, and CODs.
Establish relationships with service providers in the jurisdiction:
Court leaders can collaborate across their jurisdictions. For example, problem-solving courts recognize that there are treatment aspects to individuals who appear in court and whose cases involve multiple social determinants of poor health. Many individuals need flexible, person-centered care to effectively address their complex circumstances. Judges have become more creative in approaches to populations with complex needs and have embraced therapeutic justice versus adversarial approaches. Judges in many jurisdictions consider leveraging treatment options rather than incarceration if an individual fails to comply with a court order due to symptoms of SMI, SUD, or COD.
Judges have become more creative in approaches to populations with complex needs and have embraced therapeutic justice versus
adversarial approaches.
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What Advice Can Jurisdictions from Around the Country Share with Court Leaders?
Begin change efforts:
Some jurisdictions suggest starting with large, inclusive efforts inviting various stakeholders to collaborate and creating topic-specific workgroups. Conversely, some jurisdictions suggest starting with available data to demonstrate the ability to answer programmatic questions with data, and then utilize that success to fuel further efforts. Where and how a jurisdiction begins their efforts will likely depend on resources
and existing partnerships within a community. Whether efforts begin with a large group or a small task force, it is crucial to gather data, agree on the definitions, and create meaningful responses. Additionally, it is essential to include community members to create awareness of the issues, obtain community buy-in, and create mutual accountability among stakeholders. As leaders of their courts and communities, judges are in a unique position to begin, expand, and improve these efforts.
Break down silos:
Judges should move away from siloed, adversarial approaches to seek collaborative solutions. Organizations should understand that there is no specific entity overseeing comprehensive services and continuity of care for individuals. In fact, many individuals use several services simultaneously, underscoring the need to coordinate responses. Working groups should create data-sharing and data-privacy agreements and memorandums of understandings (MOUs) to outline the expectations of involved organizations. Stakeholders should share their knowledge, listen and compromise when faced with opposing viewpoints, and propose solutions to multi-system issues. While stakeholders may disagree
on some topics, it is valuable to reinforce the message that everyone is working toward common goals to address issues that impact community systems and, most importantly, individuals and their families.
Establish support from leadership:
It is imperative during reform to secure the support of leaders across systems. By engaging cross-system leadership, a culture of change can flow downstream through organizations. A successful model for innovative problem-solving communities is through a champion of the effort who commits to finding solutions addressing the root causes of problems. A champion such as a judge can convene stakeholders, overcome barriers, and maintain a sustained level of dedication among stakeholders.
63
Ensure the right people are in the right roles:
Cross-system data are messy and often dissimilar by definition and format. Such data are best understood by individuals with intimate knowledge of the community, its history, and services. Therefore, many jurisdictions voiced the importance of having dedicated individuals who are familiar with data as point people. Moreover, information technology staff play an important part in collecting, integrating, housing, and
extracting data from various systems in a sustainable, secure, and accessible way. It may be beneficial to house these data experts centrally in the courts.
Create a coordinating council:
A coordinating council, oversight committee, or similar working group dedicated to convening stakeholders and outlining avenues of future work is important for the success, sustainability, and collaborative nature of efforts. A coordinating council can serve as a neutral group where stakeholders collaborate and share ideas related to the development and implementation of effective policies and practices. Additionally, existing councils and committees that judges may already lead can be a starting point and backbone support for efforts.
Anticipate challenges:
The issues leading to change are multifaceted; therefore, sustained efforts to implement meaningful changes will not occur overnight. Common hurdles that jurisdictions face when sharing data across systems are the Health Insurance Portability and Accountability Act (HIPAA; for more information, please visit https://www.hhs.gov/hipaa/index.html), which outlines what personal health information can be shared and under what circumstances, as well as Title 42 of the Code of Federal Regulations (42 CFR), part 2 of which relates to personal SUD information (for more information, please visit https://tinyurl.com/ybl9vz72). While questions and common misconceptions regarding HIPAA and
42 CFR 2 pose challenges to data sharing, it should not deter jurisdictions from understanding how data can be used to better serve individuals. Jurisdictions should work closely with legal counsel and HIPAA compliance officers to understand the intricacies of sharing individual-level data across systems. In some cases, an MOU or data-sharing agreement may not be sufficient, and jurisdictions will need to consider obtaining
individual consent for the release of information.
Make data-driven decisions:
Data can inform how to save, reinvest, and target resources to reach people more effectively. Data should be utilized to educate individuals, inform programs and policies, and serve as neutral evidence of the need for the creation or expansion of services. For example, data matching regarding those with SMI and individuals who engage with other community systems will help courts understand if specialized dockets are being utilized by their target populations. In Seattle, for example, data revealed that treatment courts were only serving about 8 percent of frequent utilizers.
Seek academic or research partnerships:
There are limitations in what judges or organizations have the capacity to do on their own. Recognizing these limitations and calling on various organizations, such as local research or academic institutions, can bridge the gap between internal capacities and project goals. These can be low- or no-cost partnerships that create a synergy around problem solving, research, data analysis, and program evaluation. Jurisdictions may also consider partnering with the National Association of Counties through the Data Driven Justice Initiative, which assists communities
in addressing the needs of individuals who cycle through various social systems (National Association of Counties, 2016), and partnering with agencies to conduct Sequential Intercept Mapping workshops (Policy Research Associates, 2017).
… data matching regarding those with SMI and frequent utilizers of other community systems will help courts understand if specialized dockets are being utilized by their target populations.
64
Incorporate peer services and supports:
Jurisdictions around the country, including Miami-Dade County and Lake County, embrace the idea of using services that connect individuals to peer specialists. Peer specialists have lived experiences, which make them uniquely qualified to assist individuals with community reentry and engagement in treatment and services. Peer services are not detrimental to care quality and result in at least equivalent clinical outcomes to usual care or services by non-peer staff, as well as positive impacts on clients’ levels of hope, empowerment, and quality of life (Bellamy, Schmutte, and Davidson, 2017).
Conclusion
The need to better identify and effectively serve individuals who frequently access and engage with various social systems relates not only to the justice system but also to important issues concerning public health and social justice. Courts have a duty not only to focus on the cost of addressing the needs of individuals who cycle through various community systems but also to respond to the core issues contributing to frequent utilizers. Judges have an important role in leading change in the justice system and identifying effective community responses to
individuals with behavioral health needs. An example of this judicial leadership is how the Honorable Steve Liefman spearheaded efforts in Miami-Dade County. Enhancing the justice system and community solutions for individuals with SMI, SUDs, and CODs can seem like a lofty goal, but efforts around the country have shown that these endeavors are not only necessary but also achievable and sustainable.
References
Bellamy, C., T. Schmutte, and L. Davidson (2017). “An Update on the Growing Evidence Base for Peer Support.” 21 Mental Health and Social Inclusion 161.

Conference of Chief Justices (2006). “Resolution 11: In Support of the Criminal Justice/Mental Health Leadership Initiative.” Adopted as proposed by the Court Management Committee, 29th Midyear Meeting, January 18. Online at https://tinyurl.com/yxywv6e9.

Fuller, D. A., E. Sinclair, H. R. Lamb, J. D. Cayce, and J. Snook (2017). “Emptying the ‘New Asylums’: A Beds Capacity Model to Reduce Mental Illness Behind Bars.” Report, Treatment Advocacy Center, Arlington, Virginia, January.

Fuller, D. A., E. Sinclair, and J. Snook (2017). “A Crisis in Search of Data: The Revolving Door of Serious Illness in Super Utilization.”
Report, Treatment Advocacy Center, Arlington, Virginia, April.

Mack, M., Jr. (2016). “Decriminalization of Mental Illness: Fixing a Broken System.” 2016-17 policy paper, Conference of State Court Administrators. Online at https://tinyurl.com/y9qgcx5s.

Mental Health Institute (2010). “Miami-Dade County Heavy User Data Analysis.” Unpublished raw data.

National Association of Counties (2016). “Data-Driven Justice Playbook: How to Develop a System of Diversion.” Discussion draft, ver. 1.0, Data-Driven Justice Initiative, December. Online at https://tinyurl.com/trxu2fn.


National Center for State Courts (2019). “Leading Change: Improving the Court and Community’s Response to Mental Health and Co-Occurring Disorders.” Project report, National Initiative to Improve the Justice System Response to Mental Illness, Williamsburg, Virginia. Online at https://tinyurl.com/ycz9ajn5.

Policy Research Associates (2017). “Sequential Intercept Mapping Workshops.” Information sheet, Delmar, New York. Online at
https://tinyurl.com/tvqmzam.


Robinson, D., and S. Gibson (2019). “Data Governance Policy Guide.” Project report, Conference of State Court Administrators
Court Statistics Committee and National Center for State Courts Court Statistics Project, Williamsburg, Virginia. Online at https://tinyurl.com/ycra9l5c.

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ACMI Giving Tuesday
#GivingTuesdaysACMI

The first Tuesday of each month from 4-6 pm Arizona time, except for holiday weekends, ACMI will have a featured guest to discuss a relevant Behavioral Health topic; after the speaker, we will discuss current issues with the Behavioral Health System attendees. This month, hear about how and why San Mateo County is creating a healing campus with homelike buildings to provide housing and cutting-edge treatment (secure residential treatment facilities) from Terry Rittgers and Scott Gurley.

Topic: ACMI Stakeholder’s Meeting

Time: December 5th, 2023, Secure Residential Treatment in San Mateo County by Terry Rittgers and Scott Gurley

January 9th, 2024, Schizophrenia & Psychosis Action Alliance by Linda Mimms

February 6th, 2024, Terros Program and Offerings by COO Jennifer Nye and CEO Karen Hoffman Tepper

March 5th, 2024 Home Inc. by Charles Sullivan

Every month on the First Tuesday until December 25th, 2025

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ACMI Giving Tuesday
#GivingTuesdaysACMI

The first Tuesday of each month from 4-6 pm Arizona time, except for holiday weekends, ACMI will have a featured guest to discuss a relevant Behavioral Health topic; after the speaker, we will discuss current issues with the Behavioral Health System attendees. This month, hear about secure residential from Cheryl Roberts, Executive Director of The Greenburger Center for Social & Criminal Justice, which is opening a secure residential in NYC; learn about Hope House, the vision, and the challenges getting to groundbreaking. We hope to learn from their lessons of the past six years.

Hope House on Crotona Park, anticipated to open in early 2025, will be an Alternative to Incarceration (ATI) for those with serious mental illness accused of a felony-level crime(s). Admission to Hope House will be dependent upon an eligible defendant knowingly entering into a voluntary plea agreement to reside at Hope House as an Alternative to Incarceration. Thereafter, the plea agreement is mandated by the judge presiding over the felony case.

Cheryl Roberts, Esq., is Executive Director of the Greenburger Center for Social and Criminal Justice, a nonprofit she founded with Francis Greenburger in 2014 to advocate for the decriminalization of people living with serious mental illness. Roberts is also a part-time City Court Judge in Hudson, New York, the first woman appointed to that role, where she presides over a misdemeanor mental health court. Prior to appointment as Judge, Ms. Roberts had the privilege of serving four Mayors as City Attorney in Hudson, New York, and 8 years as a Town Judge in Columbia County, New York. In addition to being a licensed bond agent for a nonprofit bail fund, earlier in her career, Roberts practiced environmental and land use law and served as a counsel to committees in both the U.S. House of Representatives and the U.S. Senate.

Topic: ACMI Stakeholder’s Meeting

Time: November 7th, 2023, Greenbuurger’s Hope House, a secure treatment facility by ED Cheryl Roberts

December 5th, 2023, Secure Residential Treatment in San Mateo County by Terry Rittgers, Yessa Calderon, and Louise Rogers

January 9th, 2024, Schizophrenia & Psychosis Action Alliance by Linda Mimms

February 6th, 2024, Terros Program and Offerings by COO Jennifer Nye and CEO Karen Hoffman Tepper

March 5th, 2024 Home Inc. by Charles Sullivan

Every month on the First Tuesday until December 25th, 2025

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The first Tuesday of each month from 4-6 pm Arizona time, except for holiday weekends, ACMI will have a featured guest to discuss a relevant Behavioral Health topic; after the speaker, we will discuss current issues with the Behavioral Health System attendees. This month, hear about Psynergy Healthcare from co-owner Arturo Uribe and Executive Director Lynda Kaufman. Psynergy Programs operates with the shared belief that recovery happens, especially when a cohesive set of supports and services are available to support and sustain it. Based in Morgan Hill, California, our organization has grown from one facility to four over the last four years, with a fifth now in development. Each campus offers clinical and residential services in a safe and supported residential area. This way, we can emphasize the best elements of a community-living experience for individuals facing various mental health challenges. We hope they expand to Arizona!

Arturo Uribe is the President & CEO at Psynergy Programs Inc. in Morgan Hill, California, United States. His vast experience includes assisting and Advocating for Individuals and Families who are navigating the California County Mental Health System•, Supervising Intensive Case Management Teams responsible for moving clients into less restrictive placement in Santa ClaraCounty• Managing clinical resources, Supporting community integration for clients previously residing in state hospitals, acute inpatient settings, and locked institutions• Individual Therapy, Couples Therapy, Family Therapy, and case management.

He has worked in various mental health systems, including:• Community Organizations•, Government Agencies• School Settings. At Psynergy Programs, I have been able to leverage my position as CEO to provide leadership with the philosophy that individuals have the power to do better when everyone works together. At Psynergy Programs, we have transformed communities and individuals by developing licensed adult residential facilities that provide a home-style setting coupled with both care and supervision and Mental Health treatment. At Psynergy Programs facilities, individuals can celebrate hope, promote personal growth, build social networks, and realize their full potential.

Experience
Psynergy Programs Inc.
President & Chief Executive Officer
January 2006 – Present (17 years 9 months)
Morgan Hill, California, United States


Santa Clara County Mental Health
24 Hour Care (Team Lead, LCSW)
June 1999 – December 2005 (6 years 7 months)


Santa Clara County Narvaez Mental Health Clinic
Psychiatric Social Worker I
June 1998 – May 1999 (1 year)
San Jose, California


Community Companions (Alliance for Community Care
Clinical Case Manager (Team Lead)
June 1990 – May 1998 (8 years)
San Jose, California


Santa Cruz County Office of Education
Teacher Assistant (CA Mini-Corps)
January 1985 – May 1990 (5 years 5 months)
Watsonville, California


Education
San Jose State University
Master’s degree, Social Work · (1995 – 1998)
San Jose State University
Bachelor’s degree, Clinical Psychology · (1989 – 1992)

Lynda Kaufmann is Director of Government and Public Affairs, managing Admission, Contracts, and Supported Housing w/ ACT + FSP
San Francisco Bay Area. She is an Experienced Public Affairs Specialist with a demonstrated history of working with individuals with SPMI (Severe Persistent mental illness) in community settings. Skilled in contract management, coaching, government contracts, policies related to behavioral health, and MediCal practices. Strong community and social services professional.

Experience
Treatment Advocacy Center
Ambassador
March 2023 – Present (7 months)


PSYNERGY PROGRAMS, INC
Director of Government and Public Affairs
April 2010 – Present (13 years 6 months)
Morgan Hill, California

Topic: ACMI Stakeholder’s Meeting

Time: October 3rd, 2023, Psynergy Programs– CoOwner Arturo Uribe and ED Lynda Kaufman

November 7th, 2023, Greenbuurger’s Hope House, a secure treatment facility by ED Cheryl Roberts

December 5th, 2023, Secure Residential Treatment in San Mateo County by Terry Rittgers, Yessa Calderon, and Louise Rogers

January 2nd, 2024, TBD

February 6th, 2024, Terros Program and Offerings by COO Jennifer Nye and CEO Karen Hoffman Tepper

March 5th, 2024 Home Inc. by Charles Sullivan

Every month on the First Tuesday until December 25th, 2025

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By Shannon Osaka

Erin Patrick O’Connor and 

John Muyskens

Reporters from the Washington Post came to Arizona to research the heightened risk for those living with Schizophrenia in our extreme desert summer heat.

Shannon Osaka and Erin Patrick O’Connor reported from Phoenix during its historic July 2023 heat wave to capture the impact on the city’s most vulnerable residents. John Muyskens, in Washington D.C., mapped Stephan Goodwin’s movements in his final hours.

Published Sept. 6 at 6:00 a.m.

Image from Washington Post Sept 6th 2023 article, Photography by Caitlin O’Hara

Extreme heat poses heightened death risk for those with schizophrenia – Washington Post

The first Tuesday of each month from 4-6 pm Arizona time, except for holiday weekends, ACMI will have a featured guest to discuss a relevant Behavioral Health topic; after the speaker, we will discuss current issues with the Behavioral Health System attendees. This month, hear about Joel R. Conger of Connections Health Solutions. He will be discussing the services they provide (psychiatric screening as well as the recent addition of Court-Ordered-Evaluations (COE),

Joel Conger is a highly experienced professional with a distinguished career spanning over 30 years in the behavioral health community in Arizona. He holds the esteemed position of Arizona Market President for Connections Health Solutions, a leading organization dedicated to serving the behavioral health needs of individuals in the state. Under his leadership, Connections Health Solutions successfully serves approximately 30,000 Arizonans each year who are facing behavioral health crises.

Before joining Connections Health Solutions, Joel served as the Associate Vice President of Behavioral Health for Molina Healthcare. During his tenure, he played a pivotal role in the procurement of integrated healthcare contracts across multiple states, including Iowa, Nebraska, Indiana, and California. His strategic contributions were instrumental in expanding the reach of behavioral health services and ensuring the seamless integration of care for diverse populations.

Joel’s expertise lies in the domain of public sector behavioral health service delivery, where he possesses acute knowledge from both the health plan perspective and as a network provider. This comprehensive understanding allows him to navigate the complexities of braided funding mechanisms, encompassing state, federal, and grant funding. His ability to navigate and optimize these funding streams has resulted in enhanced access to vital behavioral health services for countless individuals in need.

Throughout his career, Joel has demonstrated exceptional leadership and accountability, consistently driving positive change and improving the lives of those with behavioral health challenges. His extensive experience and in-depth understanding of the field make him a trusted authority in the behavioral health community in Arizona and beyond.

Joel Conger is committed to making a difference in the lives of individuals facing behavioral health crises, and his contributions continue to shape the landscape of behavioral healthcare delivery in Arizona.

Topic: ACMI Stakeholder’s Meeting

Time: September 12th, 2023, 04:00 PM Arizona, Connections Health Solutions by Joel R Conger,

October 3rd, 2023, Psynergy Programs– CoOwner Arturo Uribe and ED Lynda Kaufman

November 7th, 2023, Greenbuurger’s Hope House, a secure treatment facility by ED Cheryl Roberts

December 5th, 2023, Secure Residential Treatment in San Mateo County by Terry Rittgers, Yessa Calderon, and Louise Rogers

January 2nd, 2024, Home Inc by Charles Sullivan

February 6th, 2024, Terros Program and Offerings by COO Jennifer Nye and CEO Karen Hoffman Tepper

Every month on the First Tuesday until December 25th, 2025

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Indeed, finding cures for serious mental illnesses is a complex and multifaceted challenge. Even the experts at the National Institute of Mental Health (NIMH) and other institutions globally often do not agree on various aspects of mental health treatment for several reasons: they cannot agree on the diverse manifestation, the biology is complicated, there are psychosocial factors, and there are philosophical differences in researcher and practitioners.

Given these challenges, it is not surprising that experts in the NIMH and other institutions often do not agree on the best approaches to treating serious mental illnesses. Some have focused on stigma reduction, and as the article below states, that seems to have been effective as more prominent people (athletes, actors, and politicians revealed personal struggles). If we could agree to focus on finding effective treatments and funding research on cures, we could achieve better outcomes. However, ongoing research and collaboration among experts are essential to improving our understanding and developing more effective treatments for mental illnesses.

Laurie Goldstein

ACMI

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What COVID Revealed About American Psychiatry

The pandemic destabilized us—and exposed the fractures in our country’s approach to mental health.

By George MakariJuly 13, 2023

What COVID Revealed About American Psychiatry | The New Yorker

Illustration by Timo Lenzen
Illustration by Timo Lenzen

As the COVID-19 pandemic eases, a mental-health crisis still has us in its grip. My fellow-psychiatrists and I continue to be flooded with referrals, desperate calls, emergencies, and relapses—likely the consequences of years of isolation and grinding anxiety, loss, school disruption, and who knows what kinds of viral assaults on the brain. Preliminary studies report elevated rates of suicide, anxiety and depression, addiction, developmental delay, and psychiatric E.R. visits. Socially marginal people, health-care workers, and the young all seem especially at risk.

COVID has left us destabilized, in the midst of what might be thought of as a psychiatric pandemic. How bad will this be? Who will escape harm, and who will suffer the most? With the virus, we eventually understood the answers to these questions and focussed our public-health efforts accordingly. But the psychiatric consequences of the pandemic will be intrinsically more complex, varied, and obscure. First, there are millions of mourners whose loved ones succumbed to covid, often in terrible, sudden ways. Then there are some who may be suffering from subtle neuropsychiatric effects of the infection. In addition, there are those stuck in chronic states of fight or flight, or helplessness—mental modes that affect our sense of time. Such people may be jumpy, irritable, violent, trigger-happy, drugged out, avoidant, defeated, morose, or self-harming, for reasons that no one can recall. Doug won’t acknowledge that he’s getting high so often because of the stress of the pandemic. Jen will be incensed if you imply that she’s cutting herself because of the difficulties of the past three years. As with traumas suffered by soldiers in war, the covid past will slip into the present, darkening the future.

How should our psychiatric-health-care system respond? “We don’t have a psychiatric-health-care system,” the public-health expert Rosemary Stevens reminded me. She’s right. Americans suffering from mental illness routinely tumble through gaping cracks in our “system.” Homeless encampments, with many people in need of psychiatric help, sprawl along beaches near Los Angeles. Vast stretches of our heartland remain mental-health-care deserts. Chicago’s Cook County Jail has in recent years been our proud nation’s largest provider of psychiatric services. As for our struggling children, good luck finding help. The other day, I ran into a pediatrician who told me that she had just sent another suicidal teen to the emergency room; the kid was eleventh in line for a bed.

If by mental-health system we mean integrated parts working together, then it’s true that America doesn’t have one. Still, we do have an array of governmental agencies, nonprofits, biotech and pharmaceutical companies, hospitals, clinics, and medical colleges—in addition to an army of researchers, epidemiologists, psychiatrists, psychologists, social workers, and therapists—that could be called upon to meet whatever post-covid challenges we face. The National Institute of Mental Health sits at the center of this constellation. Founded in 1949, the N.I.M.H. was originally charged with leading America’s mental-health research, prevention, and treatment efforts after the Second World War, when startling numbers of veterans had “become mentally unbalanced in fighting for their country,” as the Post put it at the time. Since then, as the self-proclaimed largest funder of psychiatric research in the world, the N.I.M.H. has dominated the mental-health-and-illness ecosystem; its priorities nourish growth or extinguish it. One might imagine that comprehending and responding to the mental-health effects of the pandemic would skip to the front of that line.

Few of my clinical colleagues believe that will happen. Their pessimism reflects not just the current state of mental-health care in our country but decades-old trends that have reshaped how we think about mental illness—shifts that have blinded us to cataclysms like the one we have just endured. What should we do to correct our course?

Psychiatry has always been a “Rashomon”-like affair, with triumphalists and vilifiers, sincere testimonials from the saved and tragic ones from the lost. It is held by some to be humane and a force for progress, yet it has offended, at varying times, religious believers, libertarians, Marxists, Foucauldians, and “hard” scientists. Critics have never been in short supply.

So I should have been prepared to have my head spin when I interviewed clinicians, historians, and prominent leaders in the field about our capacity to respond to a post-COVID mental-health crisis. One day, I spoke to Allen Frances, the editor of the fourth Diagnostic and Statistical Manual of Mental Disorders, who was not optimistic and looked back in regret. “For me, the tragedy is that, on my watch—the last sixty years I’ve been involved in psychiatry—we have seen the care of patients deteriorate, not improve,” he said. The next day, Herbert Pardes, a former N.I.M.H. director, was more upbeat. Surveying the same time period, he noted that the stigma long attached to mental illness had diminished, and that new knowledge and treatments had blossomed.

Both, it turns out, are right. Psychiatry is composed of three intertwined enterprises: community care for sufferers; a medical specialty devoted to diagnosing and treating patients; and research programs focussed on mind/brain science. At their best, all three efforts aid and constructively challenge one another. But, in this country, during the past few decades, each has gone its own way. This fragmentation has been dramatic, tragic, and certain to compromise our capacity to respond to the post-covid crisis.

The availability of community care—essentially, food, shelter, and support for people with mental illness—is shaped by social values regarding those in need. Those ethical commitments have fluctuated over time. In the early nineteenth century, enlightened Western nations built asylums that were mostly justified in humanitarian terms, but those places of respite eventually became too-big-to-care institutions that warehoused and brutalized their occupants. In postwar America, as the welfare state came under increasing attack, and criticism of these so-called snake pits grew louder, state asylums closed. The sickest and poorest never made it to underfunded—or often unfunded—community mental-health centers. With the emergence of managed-care insurance, in the nineteen-eighties, shockingly short in-patient hospital stays led to still symptomatic patients’ being routinely discharged to the street or swept up into prison. There wasn’t funding for anything better. That is still the case. Should a mental-health epidemic strike us, there is no one to provide care at that scale.

This grim picture is made more painful by contrast with what the medical field of psychiatry, along with its allied disciplines, now can do. Médecine mentale, as it was once called, has long sought to stabilize itself with clear diagnoses and treatments; owing to the mysteries of the mind and brain, it didn’t get too far. Forty years ago, however, American psychiatry found its footing: the third edition of the Diagnostic and Statistical Manual cut free speculative claims about causation, sticking to diagnostic categories based on reliable and coherent clusters of symptoms and signs. Clinicians of all stripes now shared a common language. In reaction to orthodox Freudians and eager lobotomists, a “biopsychosocial” perspective took root, which encouraged practitioners to shun ideology and pragmatically address the biological, psychological, and social aspects of mental illness. Psychoanalysis grudgingly made room for an array of empirically validated psychotherapies. Medications such as Prozac, Effexor, and Risperdal emerged; they were mostly safe and, if not curative, often very helpful.

All these changes were accompanied by publicity campaigns attacking stigma. Mental disorders, we were reminded on billboards and in commercials, were no different from diabetes or any other illness. This work paid off. Today, princes, athletes, senators, and celebrities no longer hide their psychic struggles. And so, paradoxically, around three decades ago, as our commitment to care for the poor and uninsured evaporated, clinical psychiatry could boast of increased social acceptance and tools that were more effective than ever.

Many disorders remained far from cured; some were fully treatment resistant. But, for those patients, there was still hope. Psychiatry’s researchers were tasked with discovering the causes of these disorders. It was a gargantuan job, and a lot depended on its success. In the eighties, Senator Pete Domenici, a loyal supporter of mental-health efforts, told the Stanford neuroscientist Jack Barchas—a point person in the effort to stop cuts to mental-health spending by the Reagan Administration—that, although the country could not afford to care for all of its mentally ill, it could support finding cures for their diseases. During the nineties, which President George H. W. Bush declared the Decade of the Brain, hundreds of millions of dollars were directed to the N.I.M.H. in that effort.

Meanwhile, the institute shed some of its original congressional mandate for treatment and prevention, by giving the job of funding mental-health services to a new federal entity, the Substance Abuse and Mental Health Services Administration. From then on, as one former N.I.M.H. director told me, undertreatment and homelessness were samhsa’s responsibilities. As the Human Genome Project launched, and brain-scanning technology leapt forward thanks to functional MRI, pressure to find genetic and brain signatures for psychiatric illnesses grew. Yet, as the new millennium commenced, a specific scan for disorders such as schizophrenia remained elusive. Dreams of single genetic causes were dissipating. A crisis was brewing.

History holds a large, unmarked graveyard filled with the ideas of those who tried to pin down the ultimate causes of mind/brain illnesses. Critics and scholars have portrayed some of the memorable failures—a procession of phrenologists, degeneration theorists, germ enthusiasts, wild psychoanalysts, political revolutionaries, and sexual liberationists. All of them pushed for their cherished notion, only for it ultimately to be found misguided, wanting, or worse.

There’s an underlying reason for all this zigzagging. Picture an archer’s target; at the bull’s-eye, place the most basic of possible causes for mental illness—say, genes. Huntington’s chorea, a fatal disease that affects cognition and movement, is solely genetic: it sits wholly at the center of the target. But other, more common conditions, such as schizophrenia and bipolar disorder, can only partly be predicted in terms of genetic risk, and, in most other forms of mental illness, genetic determinism further diminishes. To fully understand those diseases, we have to start looking to the next ring in the target. What else might be at work? We may now take aim at neurons, then jump out to neural circuits and networks, then to the entire brain with its hundred billion neurons and trillions of synapses. At any of these different levels of biology, a pathogenic event might disrupt us.

As if that were not enough to overwhelm us, there is much more to consider. Next, our psychiatric archers must move their focus from the brain to the mind, bump up against the mind-brain problem, hurry past dozens of philosophers, and simply grant that minds, in part, can cause things to happen. After that, they must turn their attention to the other outer rings, such as the self, individual behavior, the social world, and the nonhuman environment. Each of those holds the possibility of specific kinds of trouble: negative thought patterns; chronic affects like fear or shame; relationships filled with abuse; deprivation, poverty, and our catchall term for many horrors, trauma; and then, in that very last circle, poisons, bacteria, and viruses.

By taking up all of the rings on that target as potentially interacting causes of illness, psychiatry captures a rich set of human possibilities, from errors in our molecules to forces like racism. Clinicians can take a shot at any of them, unleashing as many arrows as they need. Prozac, psychotherapy, leaving a brutal spouse? Yes, yes, and yes. But experimental science requires studies that reduce a vast field of variables to an independent one whose effect can be tested. Unlike a psychiatrist working with a patient, a scientist in search of a soluble problem must limit herself to only one spot. And so psychiatry has long been a scientifically unstable discipline; it has veered back and forth between different explanatory models because its object of study, the mind/brain, presents the most overwhelming array of epistemological problems in all of medicine. In our quest for valid and reliable answers, it’s easy to get lost.

In 2002, at a moment when the clinical promise of the Decade of the Brain remained unfulfilled, it came time to choose a new N.I.M.H. director. Thomas Insel, a leader in the quest to find biological explanations for complex behaviors, got the job. Insel was brilliantly successful, famous for illuminating the role of the hormone oxytocin in eliciting bonding behavior in voles—an important finding in the emerging field of social neuroscience. Frustrated by the weaknesses in the nation’s mental-health-research program, he concluded that they stemmed from one of the foundations of clinical work: DSM-III was serving practitioners and patients well enough, but its categories were sometimes too muddy for researchers in search of well-defined scientific targets. How many specific kinds of depression lurked in “D.S.M. 296.31, Major Depressive Disorder, Recurrent, Mild”? Most experts would guess that there were many. And, if one did not tease apart those variants, how could anyone figure out what caused Jim’s depression but not Jane’s, why Zoloft worked on Amelie but not Eli?

In 2010, Insel and his team unveiled the Research Domain Criteria, or rdoc, a new framework for the study of mental disorders that introduced its own nomenclature and benchmarks. The move seemed to separate scientific research from the language and culture of patient treatment—a divorce made more bitter when Insel suggested that DSM categories were mere constructs “based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

rdoc’s influence was felt across the institute’s research portfolio. It aspired to be objective. It also prompted scientists to ask questions about disorders in a very specific way. You could study problems like hyperactivity in kids, post-traumatic stress disorder in rape victims, or self-harm in adolescents—but, to maximize your chances of being funded, your study had to incorporate a measurable characteristic, such as a gene or neural circuit, that reflected an underlying biological process. In a 2013 ted talk, Insel, standing before mesmerizing brain scans and images of neurons, assured his audience that new knowledge based on this approach—he had previously called it “clinical neuroscience”—would soon sweep away two centuries of psychiatry.

Since then, this new paradigm has powerfully altered what psychiatric scientists look for—and what they look past. For example, researchers have discovered hundreds of genetic loci associated with schizophrenia and with major depression, and more than fifty for bipolar disorder and autism. Each time a new correlation is found, geneticists celebrate. But, as E. Fuller Torrey, an advocate for the severely mentally ill, told me, so much success has added up to failure. “They have identified a lot of risk genes, not any that cause a disease,” he said. “That’s very embarrassing to them.”

Insel left the N.I.M.H. in 2015, and later confessed that one of the reasons he did so was this same dispiriting realization. In a 2017 interview, he elaborated on his departure. “I spent thirteen years at N.I.M.H. really pushing on the neuroscience and genetics of mental disorders,” he said. “And when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.” When I spoke to Insel recently, he said, of rdoc, “I think it became an academic exercise. . . . You want to pick up measures that actually are of value to patients, families, and providers. And rdoc got way too complicated. It wasn’t really tied to clinical outcomes in a way that would matter.”

Meanwhile, a decade spent in search of so-called biomarkers crushed clinical investigators who had been trained to use descriptive DSM categories and who aimed their studies at symptom relief and therapeutic impact. By 2015, only around ten per cent of the N.I.M.H. budget was directed toward clinical research. Psychotherapy researchers, who had made much progress before rdoc, saw their funding dry up. Barbara Milrod, of Albert Einstein College of Medicine, told me, “I am angry, as a psychiatrist and as a clinical researcher, because we are doing nothing for our patients and losing generations of researchers and methods.”

Imagine a lighthouse keeper whose beam and horn guide ships in storms. Imagine that this operator, in an epiphany, realizes that all the difficulties he encounters come from water and air. He determines to study the chemistry of H2O and O2. This steward is no eccentric but rather a prestigious and powerful voice in his field; thanks to his financial largesse, many others follow his lead. They all stop worrying about their beacons and foghorns, and no longer bother with weather reports, tides, or distress signals from vessels. When called to task, they assure those whose loved ones have drowned that, though it might take fifty or a hundred years, the riddle of water and air will eventually be solved.

Sound ludicrous? But where were our psychiatric sentinels as opioids, alcoholism, and suicide ripped through the struggling towns of middle America? It took two economists, Anne Case and Angus Deaton, vacationing in Montana, to notice the early mortality of white males around them, and, in 2015, alert us to the shocking numbers of what they called “deaths of despair.” Why did the mental-health-research community fail to notice this? One reason, perhaps, is that there is no gene for social collapse.

The covid pandemic, with its complex biopsychosocial effects, was a cataclysm that emerged from our environment, and its psychiatric consequences have only begun to be understood. Much of its impact, I fear, might simply be ignored, because many of our lookouts remain intently focussed on threats from the opposite end of the causal spectrum. While we concentrated on things like neural circuits, a viral menace attacked. The fear, helplessness, and isolation that it created roiled our communities and families, put great pressure on our emotional and psychic lives, and deeply affected our children. We need to pivot so as to better comprehend those realms, for the pandemic has thrown overly reductive assumptions about neuroscience into contradiction. Yes, malfunctioning brains can make us ill, but three years of death, uncertainty, and angst have demonstrated a homespun truth: the world can really mess you up.

The United States has the most funding for psychiatric research in the world, arguably the greatest array of professional talent, and significant private and public capacities. And yet the rising tide of mental illness after covid will only highlight how our social contract with those patients has long been broken. The idea that shelter and humane care are human rights has dedicated advocates but little political power. In addition, although clinicians are armed with medications and therapies, they have long been pleading for new and better tools. Guidance about what this once-in-a-century pandemic might bring their way should come from our scientific and public-health leaders in Washington, but they are divided, with separate fiefdoms for psychiatric research, alcohol abuse, drug abuse, epidemiology, and the delivery of services. We suffer from systemic failures that seem to be no one’s responsibility.

A notable exception, Vivek Murthy, the Surgeon General, has called attention to the post-pandemic psychiatric crisis, citing burnout among frontline health workers, a spike in teen suicide, and an “epidemic of loneliness and isolation.” But who will take up his call? The National Institutes of Health has created the recover initiative, which will support studies of the medical aftereffects of covid, and Congress has allocated a small amount of money directly to the N.I.M.H. for covid-targeted research. It’s not obvious what will happen when those funds run out.

To be clear, no one I spoke with advocated for calling off the Mars mission to understand the brain; exciting work is being done in optogenetics, in circuit dynamics, and in mapping the brain’s structural network (the “connectome”), to name just a few domains. It is critical that the U.S. invest in such basic research. Similarly, it would be unconscionable not to pursue solid, clinically relevant neuroscience. But there needs to be an adjustment. When I spoke to the present N.I.M.H. director, Joshua Gordon, he admitted that the introduction of rdoc had come at a cost. “It wasn’t communicated to the scientific community in a way that they understood. They took it as a kind of severing of the N.I.M.H. from diagnostic frameworks,” he said. “In my opinion, what should have been said was that it’s clear that there’s heterogeneity within our disorders, and there’s overlap across our disorders. The diagnostic labels are useful. But they have not proven tremendously useful in terms of uncovering biology.” Since Gordon’s appointment, in 2016, the N.I.M.H. has somewhat relaxed its focus on rdoc methodology. When I queried him about its value, he said, “Certainly I emphasize it less than my predecessor did.” Yet rdoc’s adoption reflected decades of at times quite strident belief that the causes of all “real” psychiatric illness could be captured by clinical neuroscience. These may not be commitments that can be easily undone.

Surrounded by this jarring disjunction between high-minded science, clinical urgency, and human suffering, I was reminded of my year as a medical intern, when a different terrifying infection was sweeping the country. On New Year’s Eve, 1987, I held a young man’s feverish hand as he fought to breathe. By then, scientists had isolated H.I.V., and the National Institute of Allergy and Infectious Diseases, led by Anthony Fauci, had begun research on a vaccine. Access to possible drugs was stalled, while gay men perished. A community rose up in protest. Fauci now recalls meetings that he had with act up and one of its leaders, Larry Kramer, as critical to the realignment of his priorities. Thankfully so. If the government had bet the house on an H.I.V. vaccine, we would still be waiting. Instead, accelerated and liberalized clinical protocols, “short-term” fixes, and deeper collaboration saved countless lives.

Today, the covid pandemic may be over, but our psychiatric crisis continues. It should serve as an alarm that shakes us out of our slumber and reframes our thinking. We need to balance our mental-health efforts to include funding more clinical trials, actively researching sociological and psychological determinants of mental health and illness, revitalizing and refining public-health efforts for early treatment and prevention, and looking for innovative ways both to care for the underserved and to provide humane asylum. Will we? Indifference, bureaucratic rigidity, and ideological opposition will likely resist such changes. Back in 1987, months before I sat up with my dying patient, act up formed. What will it take this time, I wonder, to remake our future? ♦

Medicaid is our social safety-net program in the United States that provides health coverage for some of the country’s most vulnerable citizens. It is essential for people with serious mental illnesses. Sadly, Medicaid law contains the IMD exclusion provision, which excludes payment for services for those unfortunate people needing long-term in-patient care. The IMD exclusion is a significant barrier to meaningful treatment for people with serious mental illness (SMI).

In addition, failing to recognize that involuntary treatment is required for many people with SMI has led to many individuals living lives without dignity on the streets or being punished in our jails and prisons.

There are many reasons why more Medicaid services are needed for the seriously mentally ill:

  • Rising Prevalence: The number of people diagnosed with serious mental illnesses is rising. As the population increases and the stigma around mental health starts to fade, more individuals seek help. This calls for a proportional increase in services. We have not seen this happening in AZ.
  • Complex Needs: Individuals with serious mental illnesses often require comprehensive, long-term, individualized care that can include therapy, medications, crisis services, and sometimes even inpatient care. The current inpatient stays are relatively short, almost always under the 15-day IMD cap. There is no artificial capitation for other medical conditions.
  • Coexisting Conditions: Many people with serious mental illnesses have co-occurring physical health issues or substance use disorders. They need integrated care services that can address all their health needs simultaneously. There is an attempt at integrated care, but there are no shining examples I am aware of.
  • Societal Benefits: Comprehensive services can reduce societal costs, such as homelessness, incarceration, and emergency medical care. Individuals with untreated mental illness often end up in emergency rooms, the criminal justice system, or living homeless, which are more costly interventions than preventive and therapeutic services.
  • Economic Considerations: Early and consistent treatment can help individuals with serious mental illnesses maintain employment and contribute to the economy. Without adequate services, these individuals are at a higher risk of unemployment and homelessness, increasing the economic burden on society.
  • Crisis Prevention: Regular access to treatment can help prevent mental health crises. Crises not only endanger the individual but also place a strain on emergency services, hospitals, and the broader community. Unfortunately, there are many police encounters with individuals in crisis who end up injured, incarcerated, or dead due to the symptoms of their disease.
  • Housing Stability: Stable housing is crucial for recovery. Sadly Medicaid does not pay for housing, only treatment when medically necessary. Refer to the ASU Morrison Institute Housing is healthcare to understand that it is not only the right thing to do for the patient but also saves society about 30% over the cost of treating unhoused people with serious mental illness.
  • Better Outcomes: Continuous access to mental health services has led to better health outcomes and quality of life. Medicaid can fill the gap, ensuring the most vulnerable have consistent access to these essential services. Providing the entire continuum of care is available.
  • Stigma Reduction: By increasing the availability of services and prioritizing mental health, society takes a step toward reducing the stigma surrounding mental illness. This can encourage more individuals to seek help when they need it. Receiving care early is essential to stopping episodes of psychosis and protecting the brain.
  • Future Savings: Investing in mental health now can lead to savings in the future. Providing comprehensive mental health services through Medicaid makes individuals less likely to require more intensive and costly interventions later on. Again refer to the ASU Morrison Institute study.

New York and California have seen the results of not enforcing treatment. Each is now taking small steps to reverse the substantial number of homeless people with serious mental illness. In summary, expanding Medicaid services for the seriously mentally ill is not only a moral imperative, considering the vulnerable nature of this population, but it’s also a wise investment. It can lead to better health outcomes for individuals, reduce societal costs in other sectors like criminal justice, and result in a healthier, more productive, and safer society.

Laurie Goldstein

ACMI

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Bill aims to support people with serious mental illnesses (nystateofpolitics.com) published August 1st 2023

The bill was introduced by Sen. Kirsten Gillibrand and Rep. Dan Goldman. (Spectrum News NY1)

POLITICS

N.Y. bill aims to bolster services for people with serious mental illnesses

BY PATRICK ADCROFT NEW YORK CITY

PUBLISHED 3:30 PM ET AUG. 01, 2023

Sen. Kirsten Gillibrand, Rep. Dan Goldman and Rep. Jerry Nadler on Tuesday touted legislation aimed at strengthening access to medical care for people living with serious mental illnesses.

The “Strengthening Medicaid for Serious Mental Illness Act,” if passed, would generate new services under Medicaid designed specifically for people living with mental illnesses like schizophrenia, bipolar disorder and major depressive disorder, the lawmakers said during a news conference at Manhattan’s Fountain House.


What You Need To Know

·   A bill introduced by Sen. Kirsten Gillibrand and Rep. Dan Goldman in June, the “Strengthening Medicaid for Serious Mental Illness Act,” aims to strengthen access to medical care for people living with serious mental illness
 
·   Gillibrand, Goldman and other New York elected officials touted the legislation during a news conference at Manhattan’s Fountain House on Tuesday
 
·  The legislation, if passed, would generate new services under Medicaid designed specifically for people living with mental illnesses like schizophrenia, bipolar disorder and major depressive disorder

The legislation would also set a national standard for care for people with serious mental illness and incentivize states to provide services to treat them.

“Those with serious mental illness have often found themselves in a devastating cycle: going from hospitals to jails to the streets, and back around again,” said Gillibrand, who first introduced the legislation along with Goldman in June.

“Frankly, it’s unacceptable and it’s inhumane,” she added. “It’s a major issue for public safety and it’s a major issue for caring for our families.”

The legislation would provide states with the ability to offer services that would help people with severe mental illness get and keep jobs. It would also allow states to provide access to support services and mobile crisis intervention teams.

States would also be required to abide by certain standards of care, such as tracking disparities in treatment, according to a news release from Gillibrand.

“We are still struggling in the aftermath of COVID, which interrupted mental health treatment for so many, especially the low-income and underprivileged individuals in our community who rely on government services, the community services that were halted,” Goldman said.

“And that’s why this bill is so important,” he added. “It’s important that we get people the treatment they need in a way that works.”