Psychiatric Disabilities/Mental Illness

Outcome data in the treatment of mental health and substance use are scarce, making quality improvement difficult. This report describes how Medicaid claims data can be combined with service-level data to improve the quality and cost-effectiveness of services provided in community mental health centers (CMHCs). It describes how CMHCs in three States have used a particular system, Service Process Quality Management (SPQM), to improve quality and achieve cost savings.

The Bazelon Center for Mental Health Law issues this call to action to inform advocates, policymakers and the public about the vital role the Supreme Court’s landmark decision plays in enabling people with mental illnesses to benefit from community life. The Olmstead decision is now 10 years old. According to the report, many people with mental illnesses remain segregated in board-and-care homes, nursing facilities and other institutions even though supportive community living is cost-effective.

In September 2004 CMS provided $3.6 million to fund MHST grants to encourage states to develop mental health systems infrastructure to implement and sustain evidence-based and recovery-oriented practices. Grants were awarded to 12 states under the Systems Change grants program. This report describes the initiatives with a focus on implementation issues and challenges and how they addressed them. Four Grantees focused solely on evidence-based practices, six on recovery practices, and two on both.

The largest and fastest growing group of Social Security disability program beneficiaries is people with psychiatric disabilities. The paper finds that combining evidence-based supported employment with mental health services could reduce the rate of disability and enable those already disabled to gain employment, potentially saving personal and government money. Four policy recommendations are given to achieve this goal.

The conference took place in May 2009 in North Carolina and focused on the global advancement of the principles of self-determination. Presenters spoke on topics including Medicaid reform, self-directed budgeting, self-employment; quality, education, advocacy; and youth, among others. Included here are slides from talks as well as essays by the organizer on the purpose of public funding for services and challenges facing Medicaid.

The brief make the case that supportive housing should be the primary housing option available though mental disability service systems. The point is based on data showing that stable, independent housing is what people with mental disabilities want and is a necessary condition for the success of other services, such as case management and addiction treatments. Further, the Americans with Disabilities Act mandates that services be provided in the most integrated setting possible.

The NQE provides free technical assistance on quality to states operating Medicaid HCBS programs. States can use the site to request technical assistance, pose questions to staff, engage online with other HCBS staff, and learn about upcoming events and NQE publications.

In 2004 the Veterans Affairs' Vocational Rehabilitation and Employment (VR&E) program was reviewed by a VR&E Task Force. It recommended numerous changes, in particular focusing on employment through a new Five-Track service delivery model and increasing program capacity. Since then, VR&E has worked to implement these recommendations. This report includes VR&E's progress in implementing the 2004 recommendations and includes additional recommendations moving forward from the Accountability Office.

Three key issues affecting the understanding of low rates of successful employment outcomes for people with mental illness are explored. These are: lack of a common definition of successful employment; lack of clear, objective, standardized data; and differences among states and programs in measuring client characteristics. Peer critiques to the data and analysis are provided along with tables comparing employment outcomes by state.

The National Council on Disability is required by law to annually submit a report on the status of the nation in achieving policies that guarantee equal opportunity for all individuals with disabilities and empower them to achieve economic self-sufficiency, independent living, and inclusion and integration into all aspects of society. The 2009 report focuses on current quality of life indicators and emerging trends that should be factored into future policies and programs.