Understanding Health Reform as Justice Reform
Senior Program Officer, Behavioral Health at Michigan Health Endowment Fund and NRI Board President, Lynda Zeller has co-authored a new paper, Understanding Health Reform as Justice Reform: Medicaid, Care Coordination, and Community Supervision. The Square One Project’s report addresses how justice and safety hinge on access to healthcare. Read the report.
The Delivery of Behavioral Health Crisis Services in Rural and Frontier Areas of the U.S., author, Kristin Neylon, Senior Project Associate at NRI, as part of an 11-paper series for NASMHPD. This paper discusses the challenges and opportunities related to behavioral health crisis service delivery and the unique effects the COVID-19 pandemic has in these communities. Besides an extensive literature review, valuable input was provided from key representatives from state, local, and non-governmental organizations in Alaska, Colorado, Nebraska, New Mexico, South Carolina, and Tennessee. Read the report.
November 5, 2020
The use of tobacco continues to be a major public health issue as it remains the principal cause of preventable illness and death. In 2017, 47% of clients treated at psychiatric facilities screened positive for tobacco use, demonstrating an even denser population impact for this behavioral health group. NRI surveys of tobacco policies and CMS client tobacco measures have continued to reveal positive impacts since 2006 with increasing numbers of tobacco-free grounds, staff training, and progress in tobacco cessation treatment and medication offerings to hospitalized psychiatric patients.
However, only 38% of tobacco users were referred for ongoing targeted services during discharge planning in 2018 with 6% accepting those recommendations at state psychiatric facilities reporting to CMS. Building upon the recommended clinical practices to improve engagement and uptake of tobacco treatment presented in the September webinar, NRI will present a companion webinar on November 18 distilling a recent survey of facility needs and barriers to tobacco cessation services with success stories from systems who have demonstrated improvements with the proportion of clients accepting continued treatment after discharge. Register here for this free event. Contact hours available.
This presentation is made possible, in part, by funding from the Smoking Cessation Leadership Center.
Impact of COVID-19 on State Mental Health Agencies Services
October 22, 2020
To understand and assess the magnitude of the impact of the COVID-19 pandemic has had on state mental health agencies services, and how these services have adapted to challenges presented by COVID-19, NRI, in collaboration with the National Association of State Mental Health Program Directors (NASMHPD), surveyed the SMHAs during the summer of 2020. This report represents the results of this survey.
This is the first of a series of 2020 State Profiles reports on the organization, services, and financing of SMHAs that NRI will be releasing over the next few months.
The Intersection of the Opioid Crisis and Rise in Polysubstance Use
The Pew Charitable Trusts recently released a new fact sheet that addresses the opioid crisis and emerging trends in polysubstance use. The fact sheet provides data on two classes of drugs that are frequently co-used with opioids: depressants and stimulants, and notes that this has contributed to the rising number of opioid overdose deaths.
Comorbid polysubstance use and mental illnesses are common in psychiatric settings and concerning. In 2016, NRI published an article in the Journal of Psychiatric Practice, in which results indicated that the prevalence of antipsychotic polypharmacy in a sample of 86,034 discharges for adult patients that received services in state psychiatric hospitals was 12%. Antipsychotic polypharmacy continues at a high rate (23%) to affect nearly 10,000 patients with schizophrenia each year in state psychiatric hospitals. Although the research from NRI focused on antipsychotic polypharmacy to treat mental illness, substance abuse, and deaths due to accidents mainly drug overdose have been identified for individuals treated in state psychiatric hospitals. The strategies from The Pew Charitable Trusts may be modified to accommodate the needs of the people served in state psychiatric hospitals, and to reduce the mortality burden in this particular population group.
Advancing Reforms to Competence to Stand Trial and Competence Restoration: Key Learnings from Two States
October 1, 2020
The August 2020 SAMHSA GAINS Center brief highlighted some of the learnings from Oregon and Nebraska, two states that took part in Center's Learning Collaborative in 2018–2019 and a Community of Practice in 2019–2020 on competence to stand trial (CST) and competence restoration (CR). The brief mentions NRI Board Member, Sheri Dawson, who is the Director of the Division of Behavioral Health in the Nebraska Department of Health and Human Services (DHHS) and the state's effort to pass a bill that requires Nebraska to develop and implement an outpatient community restoration process by July 1, 2021. Read more.
National Dialogues on Behavioral Health 2020
September 17, 2020
The focus of the National Dialogues on Behavioral Health 2020 is focused on the new realities of the Covid-19 Pandemic. Starting today, the virtual conference will convene over six consecutive weeks to address the emerging issues and innovations related to the behavioral health crisis response in this new environment.
- For Session 1 scheduled for Thursday, September 17 at 2:00 pm ET, NRI Board Member and Commissioner, Georgia Department of Behavioral Health, Judy Fitzgerald will present Behavioral Health Crisis Response and COVID-19: National, State, and Local Responses
- For Session 5 scheduled for Thursday, October 15, NRI’s Senior Project Associate Kristin Neylon will present Technology, Behavioral Health Apps and Telehealth Platforms: Best Practices in Technology and Behavioral Health
- For Session 6 scheduled for Thursday, October 22, Dr. Debra Pinals, Medical Director of Behavioral Health and Forensic Programs for the Michigan Department of Health and Human Services and a member of NRI's Mental Health/Criminal Justice Board Committee will present Behavioral Health Crisis Response for Persons with Special Needs (Intellectual Disabilities, Deaf/Hard of Hearing, Children, and Adolescents)
- Dr. Mary Smith, NRI Senior Consultant, Former Associate Director of Decision Support, Evaluation and Services, DMH, IL serves on the conference’s Executive Committee. The full conference agenda is available online.
September 3, 2020
In this week’s issue of Psychiatric News, the newsletter of the American Psychiatric Association, an article discusses how a subgroup of the APA Presidential Task Force on Assessment of Psychiatric Bed Needs in the United States is working on defining the various kinds of psychiatric beds in a community. The article is based on interviews with NRI's Senior Director of Government & Commercial Research, Ted Lutterman and Medical Director of Behavioral Health and Forensic Programs for the Michigan Department of Health and Human Services and a member of NRI's Mental Health/Criminal Justice Board Committee, Dr. Debra Pinals. Read more.
NASMHPD Leadership Reflects on Impact of COVID-19 on Behavioral Health
August 20, 2020
In a published Open Forum article currently posted on-line in Psychiatric Services, current and former members of NASMHPD’s leadership reflect on the impact of the ongoing COVID-19 pandemic on the state of behavioral health in the U.S. Read more.
Taking Stock of COVID-Fueled Trends That Are Shaping Behavioral Healthcare
August 6, 2020
Ron Manderscheid, Executive Director, NACBHDD and NARMH and NRI Board Member writes about where behavioral healthcare currently stands on our COVID-19 response, as well as how the field is likely to change during the next several months. Read more.
NRI Presents at NASMHPD Annual 2020 Commissioners Meeting
August 6, 2020
At the end of July, NRI staff presented at this year's NASMHPD Annual Meeting.
Kristin Neylon, Senior Project Associate presented with NRI Board Member, Dr. Ron Mandersheid about the delivery of crisis services in rural and frontier areas of the U.S. She also presented the opportunities afforded by technology in facilitating the delivery of these services.
Robert Shaw, Senior Project Associate presented about how the funding of mental health crisis services has relied on state general funds and Medicaid despite the passage of two parity acts. States have organized the provision of crisis services differently, including how services are funded but all states have it within their power to bill private insurance for crisis service. Doing so will take the cooperating and hard work and possibly the reorganization of their crisis service system.
NRI Surveys State Mental Health Directors on Impact of the COVID-19 Pandemic on Operations of Public Mental Health Systems
July 9, 2020
NRI and NASMHPD have been working with an Advisory Group of State Mental Health Agency leaders to develop a short survey of State Mental Health Directors to help us and states understand what the impacts of Covid-19 have been on public mental health systems.
The survey was developed with guidance from volunteers from a number of states, NRI, and NASMHPD staff and addresses the impact of Covid-19 on:
- state psychiatric hospitals
- SMHA-funded or -operated community mental health providers
- state mental health crisis systems, and
- the use of telehealth, what of the modified rules regarding telehealth have been most useful, and what states would recommend be retained after the public health emergency has ended.
If you are a State Mental Health Director, you should have received the survey by email from NASMHPD or NRI last week. Please check your email to make sure you have not overlooked it. You may also access the survey online here. NRI will be sharing the results of this survey with NASMHPD and all states as soon as we have responses from most states. Please send the completed survey to NRI’s Ted Lutterman at email@example.com by July 10 and please feel free to contact Ted at 703-738-8164 with any questions. A summary of survey results will be provided in an upcoming spotlight.
Early Serious Mental Illness Treatment Locator
June 25, 2020
SAMHSA’s Early Serious Mental Illness Treatment Locator is a confidential and anonymous source of information for persons and their family members who are seeking treatment facilities in the United States or U.S. Territories for a recent onset of serious mental illnesses such as psychosis, schizophrenia, bipolar disorder, or other conditions. These evidence-based programs provide medication therapy, family and peer support, assistance with education and employment, and other services.
SAMHSA has integrated data on first-episode psychosis programs that was provided by NASMHPD and the NASMHPD Research Institute (NRI) into its existing treatment locator. Users receive information on Coordinated Specialty Care and other first episode psychosis programs operating in their state. This tool is designed to help quickly connect individuals with effective care in order to reduce the risk of disability. Access the SMI Treatment Locator
Creating Quality, May 2020, Devoted to Sharing the Quality Improvement Initiatives at Several Psychiatric Facilities
June 11, 2020
The journal highlights the experiences of three facilities that had taken significant steps to improve care, the underlying documentation which is the evidence of that care, and the development of clinically useful tools to assist the clinical staff with staying on-track with best practices. NRI staff authored two articles on how to spread the word and one article on how to actively engage clinical staff in quality improvement. The journal concludes with a Call to Action to share the vital learning that comes from local quality initiatives that could benefit the wider psychiatric community in promoting the best practices for both patient care and improved outcomes. Read the latest issue.
HRSA Awards Additional Funding to Support Telehealth During COVID-19
May 28, 2020
The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), recently awarded $15 million to 159 organizations to increase telehealth capabilities in response to the COVID-19 pandemic. Read more.
Permanent Supportive Housing Associated with Long-Term Medicaid Savings
May 14, 2020
A University of Pittsburgh Medicaid Research Center study showed that in Pennsylvania, Permanent Supportive Housing (PSH) total Medicaid spending decreased by 13% by the third year after PSH entry. The largest relative declines were for non-behavioral health inpatient care and residential behavioral health care spending. Learn more.
Telehealth Surges: Effectiveness, Barriers & Will It Last? Comments from Dr. Joe Parks
April 30, 2020
New guidance from the federal government helped clear the way for Telehealth, which had been restricted to rural areas, and was made available to patients across the U.S. during the COVID-19 pandemic. Recently, Dr. Joe Parks, a member of NRI's Board of Directors, discussed the future of telehealth and barriers to telemedicine with WFYI for NPR radio. Read or listen to the full story.
May is Mental Health Awareness Month
Nearly 450 million people worldwide are currently living with a mental illness, yet nearly two-thirds of people with a known mental illness never seek treatment. In 2020, the theme is Tools 2 Thrive and aims to provide practical tools that everyone can use to improve their mental health and increase resiliency regardless of the situations they are dealing with.
May is also Borderline Personality Disorder Awareness Month. BPD has historically been viewed as difficult to treat. But, with newer, evidence-based treatment, many people with the disorder experience fewer or less severe symptoms and improved quality of life. Learn more by downloading or ordering free copies of National Institute of Mental Health's BPD brochure.
Additionally, there are weeks in May dedicated to specific areas of mental health:
Resources for Mental Health Awareness Month are available. Additional COVID-19 resources are also available.
April 16, 2020
Two recent articles highlight advice and guidance from psychiatrists and mental health professionals about treating those with serious mental illness (SMI) during the COVID-19 Pandemic.
- Expert Offers Guidance on Helping Seniors Handle COVID-19 Stresses
- Psychiatrists Offer Insights, Guidance Regarding SMI Patients During COVID-19 Pandemic
The American Psychiatric Association's SMI Adviser Website has a wealth of resources available for clinicians about COVID-19 and Serious Mental Illness. Resources include: educational activities, telepsychiatry, FAQs, mental health effects of COVID-19, and evidence-based practices to ensure continuity of care. NRI and NASMHPD serve in an advisory role for SMI Adviser, and work to identify evidence-based resources for inclusion in SMI Adviser's Knowledge Base. NASMHPD has provided resources that can be found here.
More States Granted Medicaid 1135 Waivers
April 2, 2020
In keeping with its commitment to ensure states have the necessary tools to respond to the 2019 Novel Coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services (CMS) have granted the 1135 waiver to 41 states as of Wednesday, April 1. All Section 1135 approval letters are available via the Medicaid website and are added as they are issued.
New Federal Coronavirus Bill Waives Medicare Telehealth Restrictions
March 19, 2020
Medicare patients seeking certain medical services—including mental health services—can now be seen using live videoconferencing in their homes. They do not need to travel to a qualifying “originating site” for Medicare telehealth encounters, regardless of geographic location, according to a guidance issued this week by the Centers for Medicare and Medicaid Services (CMS). Read more.
March 5, 2020
Debra A. Pinals, MD, Medical Director of Behavioral Health and Forensic Programs for the Michigan Department of Health and Human Services and a member of NRI's Mental Health/Criminal Justice Board Committee authored Lessons from the International Community to Improve Mental Health Outcomes, which pivots from NASMHPD’s previous work in its Beyond Beds series to look beyond the borders of the United States to other countries for examples of successful and promising strategies across nine areas of focus. Learn more.
February 20, 2020
Ron Manderscheid, NRI board member and the Executive Director of the National Association of County Behavioral Health & Developmental Disability Directors (NACBHDD) will be teaching the course Knowledge for Managing County and Local Mental Health, Substance Use, and Developmental Disability Authorities as a part of the Johns Hopkins Bloomberg School of Public Health, starting this spring. Learn more.
February 6, 2020
The NRI Board of Directors, primarily comprised of State Mental Health Agency (SMHA) Commissioners and their senior staff, has initiated a new State Profiles System (SPS) to provide SMHAs with up-to-date information about the financing and organization of state mental health systems. For over 20 years, NRI has been providing SMHAs information about the organization, funding, operation, services, policies, statutes, staffing, and clients of all SMHAs across the U.S. States, NASMHPD, and advocates use this information in budgeting, planning, and evaluating state mental health systems and in responding to requests from Governor’s, Legislators, media, and advocates.
The 2020 SPS Components were sent to all SMHAs on January 14, 2020 and responses are due from states by March 20, 2020. NRI will begin producing topical reports utilizing the Profiles data soon after state responses are finalized.
The SPS components for 2020 were developed with guidance from an advisory group comprised of SMHA Commissioners, Planners, and program staff, as well as staff from NASMHPD and NRI. The 2020 SPS components build on prior years’ components, but have been tailored to address new issues facing the states, and edited to ensure that only relevant information is included. Based on major policy topics raised by SMHA Commissioners and their senior staff, the 2020 SPS includes expanded components addressing Forensic Mental Health Services (including a focus on competency assessment and restoration activities in hospital and community settings), and a new Residential Continuum of Care component addressing housing options and supports provided by the SMHA for individuals with mental illness.
The updated 2020 SPS is a self-funded effort by the SMHAs that recognize the value in having access to an up-to-date, comprehensive database of comparable information about all SMHAs that states can use for budgeting, planning, and policymaking at the local, state, and national levels. Having access to this information will provide critical information to SMHA leadership and will reduce the burden on SMHAs of compiling information for decision-makers, planners, researchers, and others through the availability of a centralized, standard compilation of information about the financing of SMHAs. To date, over half of the states have committed to helping fund this initiative.
Every state that completes the 2020 SPS Components will receive general reports showing state and national trends. However, states that financially support this initiative will also receive more expansive, customized state reports with additional details and trends. For more information about supporting this important initiative, please contact NRI’s Executive Director/CEO, Tim Knettler at firstname.lastname@example.org or 703-738-8160.
State Residential Treatment for Behavioral Health Conditions: Regulation and Policy Environmental Scan
January 23, 2020
A new report by the Assistant Secretary for Planning and Evaluation (ASPE) on state regulation of Residential Treatment programs was prepared for ASPE by Truven/IBM. NRI and NASADAD also worked to identify state regulations and facilitated state review and verification of the information summarized for the ASPE report.
The objective of this environmental scan is to summarize the peer-reviewed and grey literature on oversight of residential care for mental health and substance use care in the United States, excluding inpatient hospital care. Read the new Environmental Scan.
NRI’s Resources Instrumental in Supporting Coordinated Specialty Care Programs for First Episode Psychosis
January 9, 2020
A recent article about Washington State's Early Psychosis Program highlights services received through a coordinated specialty care (CSC) program called New Journeys. NRI has produced numerous resources designed to help states implement and fund coordinated specialty care programs. Additionally, these resources help CSC programs adhere to best practices and to be culturally competent serving a diverse client base. You can access these resources on our website.
December 19, 2019
NRI and NASMHPD are again working with the American Psychiatric Association’s SMI Adviser, also referred to as the Clinical Support System for Serious Mental Illness (CSS-SMI). This SAMHSA-funded center supports mental health providers to promote person-centered treatment and recovery supports to individuals with SMI. A major task that we are working on with the APA to support this endeavor is an assessment of state mental health systems and their providers to understand their needs regarding how to improve clinical services for individuals with SMI.
To help us determine what types of assistance are most needed in the implementation of Evidence-Based Practices and Clinical Practice Guidelines, NRI is distributing a survey to State Medical Directors, State Hospital Administrators, and CSC Program Leads in each of the states. This 10-to-15-minute survey will help the APA and SAMHSA better understand what types of clinical consultations, training, and other TA would be especially helpful to these audiences. Information from these surveys will be used to help inform the TA activities provided under the CSS-SMI initiative to better meet the needs of behavioral health providers and clinicians. NRI is requesting that these surveys be completed by Friday, December 20th. If you feel you should have received an invitation to participate in this survey but did not, or if you have any questions related to this initiative, please contact Kristin Neylon.
Research Report Finds Widening Disparities in Network Use and Provider Reimbursement for Individuals with Mental Health and SUD
December 5, 2019
A recent report titled, “Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement” showed that there are increasing disparities in out-of-network utilization rates for addiction and mental healthcare services compared to medical and surgical services for inpatient, outpatient, and professional office-based settings.
In this article by Kaiser Health News, Dr. Henry Harbin, an adviser to the Bowman Family Foundation, which commissioned the report comments on the reports’ findings. Dr. Harbin was the former CEO of Magellan Health, a managed behavioral health care company. Read the report.
NRI Welcomes New Senior Director of Consulting and Research
November 21, 2019
NRI welcomes Dr. Jennifer Bronson as our new Senior Director of Consulting and Research. Dr. Bronson has 15 years of experience in health research and evaluation, with a primary focus on behavioral health, disabilities, HIV/AIDS, maternal health and children’s exposure to violence/trauma. Her criminal justice knowledge comes from experience working in a reentry services center and at the Department of Justice as a correctional health statistician. She has a PhD in Medical Sociology from Howard University. Please join us in welcoming her.
SAMHSA Releases Publication on First-Episode Psychosis and Co-Occurring Substance Use Disorders
November 7, 2019
NRI's Board President Dr. David Shern and Senior Director, Ted Lutterman served as members of the expert panel.
The Substance Abuse and Mental Health Services Administration (SAMHSA) announced the release of a new publication titled, “First-Episode Psychosis and Co-Occurring Substance Use Disorders.” The evidence-based resource notes that young adults who experience a first-episode psychosis along with a substance use disorder (SUD) are at high risk for recurring episodes of psychosis, later physical health problems, and have a greater likelihood of future disability. Read more.
New, Unique Report: Functionality and Usability of Various Electronic Health Record Systems: State Psychiatric Hospitals and Systems
October 24, 2019
Electronic Health Record (EHR) technology varies not only by vendor but also by implementation. In this latest report, Lucille Schacht PhD, CPHQ, NRI’s Senior Director Performance and Quality Improvement, discusses the components that have been implemented and the perceived usability of the EHR system. Learn more.
NASMHPD Annual Meeting
September 19, 2019
The NASMHPD Annual 2019 Meeting, which was held in conjunction with the International Initiative for Mental Health Leadership (IIMHL) and the International Initiative for Disability Leadership (IIDL) Leadership Exchange Network meeting took place from September 11-14 in Washington, D.C. NRI staff and board members participated in panels and presentations.
Below are links to the presentations and related materials:
- Science to Service: Improving Care for Early Psychosis presented by Susan Azrin of NIMH, and moderated by NRI Board President David Shern
- Effects of CMS's Measure of Antipsychotic Prescribing Practices for Nursing Facilities presented by NRI Team Member Kristin Neylon, Emily Gadbois and Jessica Ogarek of Brown University, and Dena Stoner from Texas's Health and Human Services Commission
- Workforce and Serious Mental Illness and Substance Use Disorders presented by NRI's Executive Director and CEO, Tim Knettler
September 19, 2019
The NRI-sponsored Mental Health Metrics Match took place September 9th and 10th as part of the IIMHL/IIDL meeting. This Match allowed participants from Australia, Canada, England, Ireland, New Zealand, Scotland, United States and Wales to share their newest and most effective uses of data to understand systems, monitor accountability, and drive innovation.
NRI's Executive Director and CEO, Tim Knettler and Senior Director of Government & Commercial Research, Ted Lutterman presented about United States/State Mental Health Agencies & Systems.