UK HEALTH POLICY FORUM Behavioral Health in the Commonwealth -Past, Present, Future

Behavioral Health on the Move… From Institutions to the Community From Isolation to Integration From Warehousing to Treatment to Recovery From Stigma to Acceptance

Who is Affected? At least 1 in 5 families (23%?) will deal with a behavioral health problem 60% of visits to a physician’s office are for symptoms of psychological problems 80% of psychiatric medications are prescribed by non-psychiatrists Individuals with serious mental illness die 25 years younger than their peers Mental illness is the #1 cause of disability

President Kennedy signing the Community Mental Health Centers Act In 1963.

The Statewide Network of Community Mental Health Centers (CMHCs) was completed in Kentucky was the FIRST state in the nation to put its statewide network in place! CMHCs were established in 1964 in KY Statute: KRS 210:370 – 485 Last Year: – 172,544 Kentuckians were served – 312 Citizens served on CMHC Boards

CMHC Data - Clients/Services/Funding LRC Program Review Report – December, 2006

Medicaid Rates frozen since 2001 growth rates at the CMHC’s

If CMHCs weren't in local communities, how would our clients spend their day? Many individuals in need of behavioral health services – but not receiving them - experience: Jail Hospital ER Alternative School or Suspended from School Institutional Placement – the “Revolving Door” Loss of Job or Employment Opportunity Homeless Shelter Life on the Streets Higher Health Care Costs and Lack of Access Suicidal Ideation or Successful Completion

Management Strategies Which Have Historically Been Employed to Maximize Dwindling Resources Maximizing Caseloads Consolidating Service Sites Increasing Waiting Times for Clients between Appointments Utilizing Telehealth in lieu of Specialty Staff on Site Increasing Demand for Staff Productivity & Efficiency while Keeping Salaries Constant Managing Employee Benefits such as Health Insurance

Effects of Chronic Underfunding While funding for the CMHCs has seen a net increase of 9%, the state General Fund budget has increased by 50% Kentucky has dropped from 1 st in Behavioral Health systems to 44 th in funding for Behavioral Health Kentucky is the ONLY state to be given a grade of “F” by NAMI in both of their state report cards (2005, 2008) Kentucky is one of only eight (8) states which does not provide substance abuse treatment to their entire adult Medicaid population

What Have We Accomplished? Kentucky has a Mental Health Coalition which is one of the oldest, most inclusive and most effective in the nation In 2000, we advocated for an insurance parity bill for behavioral health services which is mirrored now in the federal parity bill The CMHCs were spared by the Governor from the last three rounds of budget cuts Advocates brought the Crisis Intervention Team (CIT) program to Louisville and now statewide to train law enforcement officers to identify and deal more effectively with behavioral health issues Kentucky has a Jail Triage program which has significantly reduced suicides in the jails and is a model program nationally Local CMHC initiatives have brought professional training and education to their communities, to retain local staff

Where Do We Go Next? We continue to support consumers and family members to combat stigma by telling their stories – “putting a face on the problem” We build our coalitions and reach out with information to educators, the faith community, law enforcement and corrections, health care providers, social services, and the business community We urge increased funding for behavioral health as a strong return on investment…although NO Stimulus $$s were allocated! We increase our attention and work on removing barriers to integrated and collaborative care We seek to exclude those with severe mental illness from the death penalty and to restore voting rights to felons who have served out their sentences for nonviolent crimes

How Can You Get Involved? Health care policy and practice need to focus always on the WHOLE person…with “no wrong door” to access needed services Remember that the legislature sets public policy and the budget is their policy document. Where does behavioral health rank? Come to Frankfort on February 3 rd or 17 th or on March 3 rd and see Advocacy in Action! Learn more about these issues at or contact me to sign up for alerts and calls to How can you NOT be involved?!? How can you NOT be an advocate?!?