1. Budget Platform

2. BACKGROUND: As Ohio’s mental health system crumbles, it is consumers and families who pay the price. We must provide sufficient funding for community-based care for Ohioans with severe and persistent mental illness. Not only is this the compassionate thing to do, it will save money by reducing the use of expensive and inappropriate institutionalization such as hospitals, nursing homes, prisons, and jails. Recognizing that there will be fewer resources available to meet the needs of those with mental health disorders in the upcoming budget, NAMI Ohio calls on Governor Elect John Kasich and the 129 th General Assembly to prioritize basic services for those with severe and persistent mental illness. Join us – be a voice for change.

3. PROBLEM: Ohio’s Medicaid Program discriminates against people with mental health disorders because it does not pay for mental health services the way that it pays for physical health services. SOLUTION: Move the responsibility for paying Medicaid to the State where it belongs so that local communities can concentrate their resources on those in greatest need.

4. JUSTIFICATION: Today, state and local funds are used to pay the 40% Medicaid match for mental health services, yet only state funds are used to pay the 40% match for physical health services. The remaining 60% is paid by the federal government. NAMI Ohio believes that the state should treat mental health services the same way they treat physical health services, and pay for the entire 40% match.

5. PROBLEM: Ohio is in violation of the Mental Health Act of 1988. When Lawmakers made the decision to move individuals with mental illness from the State’s hospitals back to the community, they promised to use the dollars that were saved to support them in the community. Unfortunately, that is not what is happening. SOLUTION: Do not cut the current level of funding in the State’s budget for the purchase of community mental health services.

6. JUSTIFICATION: When the Mental Health Act of 1988 was passed, the state closed six mental health institutions. The money used to fund these hospitals was supposed to follow the clients back to the community and be used to pay for treatment, housing, transportation and other community support services. Over the years, these funds have eroded. The state has an obligation to take care of those who otherwise would be living in mental health hospitals today if they had not been closed. Instead, the state has come to rely on our jails, prisons, hospitals, nursing homes and homeless shelters to care for these individuals.

7. SOLUTION: Include language in the state statute directing local Boards to provide critical services and supports for adults and children with chronic mental illness before they can spend state or local dollars on less critical services. PROBLEM: Adults with severe and persistent mental illness cannot participate in their recovery if they don’t have a roof over their heads, food in their stomachs, and someone who cares that they get well. Children with serious emotional disturbance cannot get well if they are torn apart from their families and placed into institutional care because there are no services or supports available to their families in the community.

8. JUSTIFICATION: Community Alcohol, Drug Addiction and Mental Health (ADAMH) Boards are required by law to fund, manage, and evaluate community-based mental health and substance abuse services. The federal, state, and local governments fund the Boards and in turn the Boards are responsible for ensuring that alcohol, drug addiction and/or mental health services are available to those who need them, regardless of their ability to pay. In a time of scarce mental health resources at all three levels of government, NAMI Ohio supports changing the law to prioritize the population who receives services and supports by the local Board to those with serious and persistent mental illness. In addition, NAMI Ohio believes that the scope of mental health services should be prioritized to ensure that the most basic of needs are met (ex. food, shelter, medication) are provided to the degree needed to remain safely in the community BEFORE funds can be spent on other services.

9. Families with a child with serious mental illness often come unraveled trying to figure out where to get help and support for their child and their family. Eventually, when the child’s behavior becomes so disruptive and help is not provided, the child ends up in a costly residential treatment facility or the juvenile justice system. Local communities need to have the flexibility to respond to the critical needs of families. Respite, door alarms, crisis counselors…these are the types of things that families often need to keep children with mental illness at home. Using levy dollars to meet the individual needs of families, rather than embracing a one size fits approach as we do currently, is the solution.

10. PROBLEM: Access to medication for those with severe and persistent mental illness often means the difference between life and death. SOLUTION: Prohibit limits being placed on access to mental health medications for those with severe and persistent mental illness.

11. JUSTIFICATION: Over the past 20 years, powerful new medications have revolutionized the treatment of mental illnesses, allowing people with even the most serious disorders, such as schizophrenia and bipolar disorder, to live in the community, maintain healthy relationships and pursue productive lives. Because of the budget crisis facing Ohio, it is likely that efforts will be undertaken to limit access to these life-changing, yet often expensive, medications. Restrictive strategies, such as prior authorization or fail first policies, may result in short term savings to the Medicaid program. However, they will be more than offset by increased costs in hospitalizations, incarceration, homelessness, loss of employment and out of home care for children. The cost in human suffering is incalculable.

12. PROBLEM: Psychiatric hospitalization in Ohio is not adequate because there are not enough beds; patients are released before they are stabilized; and patients are not linked to community services and supports upon release. SOLUTION: Offer incentives to hospitals that accept Medicaid patients to provide more psychiatric beds. Prohibit state hospitals from releasing patients until they are stabilized. Require that patients are linked to services and supports in the community, including appropriate housing, prior to being released.

13. JUSTIFICATION: The average length of stay for acute hospital care in a mental health hospital in Ohio is less than two weeks. The average length of time for most mental health medications to take full effect is well over three weeks. Needless to say, many people who are released from mental health hospitals are in no better shape to live in the community than they were when they were admitted to the hospital. Additionally, individuals who are released from the hospital often are unable to return to the place they lived prior to hospitalization for a variety of reasons. If hospitals cannot readily find a suitable living arrangement, they send them home to families who are unable and unprepared to manage their illness, or they are released to homeless shelters or the streets with no services or supports.

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