Nation’s Mental Healthcare System Gets “D” Grade

Posted on March 1, 2006

Washington, D.C — The United States gets a D grade in helping adults with serious mental illnesses, according to the first state-by-state report on the nation's mental healthcare system in more than 15 years.

Grading the States: A Report on America's Health Care System for Serious Mental Illnesses , funded by the Stanley Family Foundation, was released by the National Alliance on Mental Illness (NAMI).

A list of state grades is included at the end of this release. The report calls on states to make smarter investment choices through proven, cost-effective practices, and to link taxpayer funding to performance and individual outcomes.

"Grades are more than report cards," said NAMI executive director Michael J. Fitzpatrick. "They reflect standards that help people recover, and choices being made by governors and legislatures every day. States doing well in the report have developed a common vision and political will to move their treatment systems forward."

For the first time, the report confirms in detail what a presidential commission appointed by President George W. Bush has called "a system in shambles" and what the Institute of Medicine of the National Academy of Sciences recently called a "chasm" between promise and practice. Grades were calculated by scoring 39 criteria, based in part on a survey of state mental health agencies conducted in October-December 2005.

Only five states received grades in the B range: Connecticut, Maine, Ohio, South Carolina, and Wisconsin.

Eight states received Fs:; Iowa, Idaho, Illinois, Kansas, Kentucky, Montana, North Dakota, and South Dakota.

"Treatment works, if you can get it, and if states get it right," said NAMI medical director Ken Duckworth. "Unfortunately, too many states are willing to risk or tolerate premature deaths."

Millions of adults with schizophrenia, bipolar disorder and major depression, depend primarily on state public health systems for treatment and support services.

Duckworth warned that Ds are unacceptable and Cs cannot be considered a passing grade. "If you need heart surgery, you don't want a surgeon who only got a C in medical school. The same principle applies in helping people with mental illnesses."

"Too many states are behind the curve. They are not keeping pace by moving toward a recovery-oriented health care system, based on proven, cost-effective practices. They are selling taxpayers short by settling for pieces of systems that are largely obsolete."

The NAMI report makes several recommendations:

• Invest in proven, cost-effective practices (i.e, evidence-based practices)
• Increase funding tied to performance and recovery
• Improve data collection
• Increase access to information
• Involve consumers and families at all levels
• Eliminate discrimination

The report particularly criticized Illinois. Besides being the only large, populous state to receive an F grade, the state ranked 46th the nation in a "Consumer and Family Test Drive" of information accessibility through the state mental health agency's Web site and telephone system. In one instance, an Illinois agency employee told a consumer: "No, I don't want to help you."

"Getting help means getting access to information," Duckworth said. "When 40 states can't pass a pop quiz on providing basic information to the people whom they are supposed to serve, then the system is in trouble."

States that received excellent "Test Drive" scores were Tennessee, Ohio, Indiana, South Carolina, Michigan, and West Virginia.

Fitzpatrick predicted the report will have policy consequences.

"Consumer and family advocates will use it as a tool for change. Governors and legislators should use it as a check list. The goal is to raise the level of awareness, dialogue and creative action," he said.

The impact may extend to national debate.

"Iowa is a prime example. It gets an F overall. Eighty-nine out of ninety of its counties are classified as rural, but the state lacks a strategy for addressing distinctive rural needs. Tell that to presidential contenders in 2008 who plan on visiting the state."

New Hampshire, he noted, was once considered to have one of the best mental healthcare systems in the nation. Today, it is one of 19 states that received a D.

Two states, Colorado and New York, declined to participate in the survey and were graded U for unresponsive. Legislative oversight committees in those states will be encouraged to seek answers to the report's questions for themselves.

GRADE DISTRIBUTION:

B Connecticut

B- Maine, South Carolina, Wisconsin

C+ Maryland, Michigan, Minnesota, Oregon

C California, District of Columbia, Hawaii, New Jersey, Rhode Island, Texas

C- Delaware, Florida, Massachusetts, Missouri, New Mexico, Tennessee, Vermont

D+ Arizona, North Carolina, Pennsylvania

D Alaska, Alabama, Georgia, Mississippi, Nebraska, New Hampshire, Oklahoma, Utah, Virginia, Washington, West Virginia, Wyoming

D- Arkansas, Indiana, Louisiana, Nevada

F Iowa, Idaho, Illinois, Kansas, Kentucky, Montana, North Dakota, South Dakota

U Colorado, New York

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