Massachusetts, Vermont, Maine, North Dakota and Delaware topped the list while the bottom five were Arizona, Mississippi, Nevada, Washington and Louisiana.
There is a high, but not perfect, correlation between states' rankings and whether they are Medicaid expansion states. Maine, third on the list, is not an expansion state. Conversely, Washington (48th), Nevada (49th) and Arizona (51st), all expanded Medicaid under ACA.
Overall, the report says that 42.5 million Americans suffer from some sort of mental illness, 19.7 million have a substance abuse problem and 8.8 million report that they have seriously considered suicide.
The MHA report also ranks the mental health of young people across the states. Vermont, North Dakota and Wisconsin top the list. Nevada, New Mexico and Montana rank last.
New Mental Health Measures
Although NAMI pointed to the retreat from state mental health spending this year, its report did note a number of new laws that it hailed as possible models for other states. Among them:
Virginia established a registry of available beds in public and private psychiatric facilities to help place individuals who meet the criteria for temporary detention as a result of mental illness. The bill arose after the mentally ill son of Virginia state Sen. Creigh Deeds stabbed his father and then killed himself with a rifle a year ago. Only hours before the incident, the young man had been released from emergency detention when officials were unable to find a hospital with an available bed where he could receive a psychiatric evaluation before being released, as required under law.
Minnesota passed a measure that would base community mental health workers in schools to handle acute mental health cases. Sita Diehl, NAMI’s director of state policy and advocacy, said, “School counselors are focused on general mental health issues. They may not be equipped to handle serious mental health in children.”
Massachusetts enacted a comprehensive "safe and supportive school" measure, which, among other provisions, encourages schools to explore mental health issues when they assess the poor performance or poor behavior of students. "Schools think in terms of academics," said state Rep. Ruth Balser, a Democrat, who sponsored the bill. "It's a matter of us educating the educators to think of the whole child."
For people in the throes of psychosis or another mental illness crisis, Minnesota now provides transportation to a hospital in unmarked cars driven by mental health professionals rather than in police cars with flashing lights and sirens. "When law enforcement is called for medical situations it's really embarrassing and humiliating for people who didn't break any law," said NAMI’s Diehl.
Illinois passed a law aimed at preventing parents with limited or no health insurance from having to relinquish custody of their severely mentally ill children to foster care to get those children intensive mental health treatment. The law requires the state to identify children at risk of state custody and work with their families to get the needed services. In the past, children were taken away from parents to get them treatment. "It was a dirty, dirty secret," said Sara Feigenholtz, the Democratic state representative from Chicago who sponsored the legislation.
Kentucky allows trained nurse practitioners to prescribe psychiatric medications, a measure intended to help patients without easy access to psychiatrists. Illinois passed a similar measure pertaining to psychologists.
At the other end of the spectrum, North Carolina approved a law requiring Medicaid patients to get authorization from Medicaid before obtaining psychiatric drugs. While supporters cited cost-savings as a rationale for the measure, NAMI's Diehl predicted it will lead to otherwise avoidable hospitalizations or arrests that will cost the state far more than the medications.
Idaho's legislature voted to allow the use of restraints with mentally ill patients without a physician’s permission. Georgia terminated the University of Georgia’s "navigator" program, which provided trained helpers to assist people trying to obtain insurance on the federal health exchange.
And Georgia, Arkansas and Tennessee all enacted measures barring promotion of ACA’s provisions or preventing those states from expanding Medicaid eligibility and improving access to mental health care.
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