1. Thomas Bornemann, Ed.D. Director, Carter Center Mental Health Program Creating Dynamic Policy Change in Mental Health

2. Outline Carter Center Mental Health Program Affordable Care Act: Mental Health and Addiction Current Issues in Mental Health Case Study: Georgias Mental Health System Conclusions

3. Carter Center Mental Health Program Founded in 1982; led by Rosalynn Carter Active internationally, nationally, and within Georgia The Rosalynn Carter Fellowships for Mental Health Journalism Liberia Public Policy Georgia

4. Affordable Care Act (ACA) : Behavioral Health Dynamic policy environment Milestone in health care policy Expands preventive services and integration with primary care Hurdles will arise in implementation but will ultimately greatly expand access to mental health and addiction services Parity issues

5. Current Issues in Mental Health

6. Foster care and adoption services Comprehensive screenings and routine checkups Collaborative partnerships with therapists and other invested parties Support for families who adopt children in the child abuse and foster care system School-based health centers can provide behavioral health services and early screenings for low-income children Juvenile Justice reform -National Center for Child Traumatic Stress Network Children and Adolescents

7. Current Issues in Mental Health Transitional age children Many mental health disorders begin in adolescence Providing solid transitional services will prevent young people from exiting the mental health system prematurely Community services should include efforts to address disparities in racial minorities, LGBT individuals, developmental disabilities and other populations with unique needs Veterans and their families Older adults - Special Populations

8. Current Issues in Mental Health Department of Justice settlements in New Jersey and North Carolina and ongoing lawsuit in New Hampshire and other states under scrutiny From 2009 to 2011, states collectively cut $1.8 billion for children and adults with mental illness (NAMI) Cuts have reduced mental health services and shifted the burden of first response for people in crisis to law enforcement officers and emergency room physicians Workforce development Policy Issues

9. Policy Investment in Mental Health Policy can lead to concrete, measurable results Nonprofits have flexibility to accomplish policy changes that government agencies and clinicians do not have Investments in policy can affect large numbers of people, and are potentially sustainable, long lasting, and cost effective

10. Case Study: Georgias Mental Health System

11. A Hidden Shame: Death in Georgias Mental Hospitals Sarah Crider, died at fourteen -Atlanta Journal-Constitution

12. Case Study: Georgias Mental Health System August 2008Carter Center Mental Health Program (MHP) gets involved in case against the state of Georgia January 2009Conditional settlement reached between Department of Justice and Georgia re: CRIPA February 2009MHP and other state and national stakeholders entered as amicus curiae July 2009Department of Behavioral Health and Developmental Disabilities created (DBHDD) January 2010Second suit filed addressing community services/Olmstead October 2010Final settlement addressing both suits finalized May 2011Carter Center releases draft of Vision Report May 2013Governor signs Juvenile Justice Reform Bill (HB 242) GA Mental Health System Under Scrutiny

13. Case Study: Georgias Mental Health System Creation of Community Services

14. Case Study: Georgias Mental Health System Complete reform of Georgias mental health system in five years despite recession Georgia mental health services are a model for the rest of the country Narrow policy intervention led to significant change Leveraged a community-based crisis system into a community-based treatment system Learning Collaborative for Integrated Care Progress and Results

15. Case Study: Georgias Mental Health System Investments from local foundations allowed The Carter Center to take a leadership role in the settlement Strong leadership by the state government Trust Engaged all parties - not weighted in any one direction Transparency Keys to Success

16. Funders for our Georgia Activities The J. B. Fuqua Foundation (GA Urgent Model Project; C&A due diligence grant) The Tull Charitable Foundation (GA Urgent Model Project) The Betty and Davis Fitzgerald Foundation (GA Mental Health Activities – Vision Document regional meetings) Healthcare Georgia Foundation (Integrated Care, Health Policy) The John and Polly Sparks Foundation (GA Mental Health Activities)

17. Conclusions Mental health is a national concern with heavy emotional and financial costs There are opportunities for investment in multiple areas: children, older adults, trauma survivors, etc. Investment in policy creates long-lasting, wide spread changes with a high economic and social return on investment

18. Thank you Thomas Bornemann, Ed.D. Director, Carter Center Mental Health Program ccmhp@emory.edu (404) 420-5165