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Record Provisional National and State Drug Overdose Data

December 2, 2021

Drug overdoses killed more than 100,000 people in the United States during the one-year period ending in April 2021, according to provisional data issued by the Centers for Disease Control and Prevention (CDC). This marks the first time that drug overdose deaths reached six figures in one year and represents a 29% increase in overdose deaths from the prior year.See link below for access to state data.

The report offers a visualization that presents the reported and predicted provisional counts of deaths due to drug overdose occurring nationally and in each jurisdiction

Behavioral Health Workforce is a National Crisis: Immediate Policy Actions for States

December 2, 2021

In a series of three issue briefs,Health Management Associates (HMA) and the National Council for Mental Wellbeing offers short-term policy levers to quickly impact workforce availability and retention. The issue of workforce availability was also the topic of a recent article in The Atlantic, that examined Why Healthcare Workers are Quitting in Droves.

Behavioral Health Call Centers and 988 Implementation

November 18, 2021

A new NRI report highlights the experiences of 43 State Mental Health Agencies (SMHAs) in working with state-funded Behavioral Health Crisis Call Centers as they prepare for the implementation of 988—the three-digit-number for the National Suicide Prevention Lifeline that must be live by July 16, 2022.

The report found that in most states, the SMHA is the lead agency responsible for crisis call centers, and that there are more than twice as many behavioral health crisis call centers than Lifeline call centers. Additionally, the report identifies efforts of states to work with 911 call centers to identify and refer behavioral health crisis calls to Lifeline and other behavioral health call centers.

We hope this report will help inform the field of state experiences working towards the exciting new launch of 988 and the implementation of a robust crisis services continuum to better help all individuals experiencing a behavioral health crisis. Read the full report

NRI Staff Present at NASMHPD's Annual Meeting 

October 28, 2021

At NASMHPD’s Annual 2021 Commissioners Meeting, several NRI staff members presented on topics associated with the meeting’s theme, Beyond Beds: Before, During, and After COVID-19. We invite you to watch their presentations: 

Phony Diagnoses Hide High Rates of Drugging at Nursing Homes

October 14, 2021

A recent New York Times investigation found, that least 21 percent of nursing home residents are on antipsychotic drugs. NRI Board Member, Dena Stoner spoke about the article and its findings:

“The recent NYT article on misuse of antipsychotics in nursing facilities further highlights trends that NRI documented in a sentinel 2017 research paper. Working with researchers from Brown University, NRI was able to access and analyze a national data set on nursing facility resident care. The resulting work documented trends in diagnosis of schizophrenia among nursing facility residents and the potential association with antipsychotic use. It also highlighted state efforts to decease inappropriate use of antipsychotics.  The research validated issues which states have observed and supports continuing efforts by states to decrease inappropriate use of antipsychotics. This example illustrates the value of NRI as a source of timely research focused on mental health topics of greatest interest to state policy makers. These include not only state mental health authorities, but state aging and disability authorities and state Medicaid agencies.”   

New AAMC Report: Complexities of Physician Supply and Demand: Projections From 2019 to 2033

September 30, 2021

Findings from a recent American Association of Medical Colleges report, The Complexities of Physician Supply and Demand: Projections From 2019 to 2034, indicate that physician demand will grow faster than supply, leading to a projected shortage across the non-primary care specialties of between 21,000 and 77,100 physicians; and between 10,300 and 35,600 for the "Other Specialties category” of which psychiatrists are included. 

According to the report, "the demand projections reflect changing demographics as the population grows and ages, the rapidly growing supply of advanced practice registered nurses (APRNs)" (of which psychiatric nurse practitioners are included) "and physician assistants (PAs), and other important trends in health care such as a growing emphasis on achieving population health goals.”  Read the full report

Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program

September 16, 2021

Each year the Centers for Medicare and Medicaid Services (CMS) organize a stakeholders meeting to discuss business items related to the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program. This year, Glorimar Ortiz, PhD, MS, the new Senior Director of the Performance and Quality Improvement Division/BHPMS at NRI, will be participating in the meeting on September 29. Dr. Ortiz will be briefed on updates about recent changes to the IPFQR program, and will report back to 150+ facilities, public and private, that currently participate in the Behavioral Healthcare Performance Measurement System (BHPMS) founded by NASMHPD.

Learn more about NRI’s Behavioral Healthcare Performance Measurement System (BHPMS)

988 Will Benefit From Tech Innovations Jump Started by Pandemic

September 2, 2021

The Covid pandemic has sparked and expanded the use of innovative health technologies in behavioral healthcare that states can incorporate and maximize as they build out their crisis systems in anticipation of 988—the three-digit number for mental health, substance use, and suicidal crises that must be live by July 16, 2022. Kristin Neylon, M.A., senior project associate at NRI shares the latest in behavioral health tech in this article from Crisis Talk

Welcome Dr. Glorimar Ortiz as NRI's New Director of Performance & Quality Improvement

August 19, 2021

NRI congratulates Glorimar Ortiz, PhD on her promotion to the Senior Director position. She succeeds Dr. Lucille Schacht who, after 22 years, retired earlier this month. 

With a background in Public Health, specifically on research and evaluation of health service systems with an emphasis in biostatistics, Dr. Ortiz has contributed to decreasing the gap in behavioral/mental health research. At NRI, she has lead the research agenda for the BHPMS, has applied advanced analytics, and has disseminated scientific information, with an emphasis on quality improvement. Her research focuses on the mortality risk, the use of antipsychotic medications, co-occurrence of mental health and substance use disorders, readmission rates, use of seclusion and restraint measures, satisfaction with inpatient care, and smoking status among people with severe mental illness served in state psychiatric hospitals. She has also provided statistical support to the NRI’s Federal and Consulting divisions. Previous to that, she performed research with vulnerable population groups such as persons living in marginalized communities, youth with mental illness in juvenile institutions, and Latina pregnant women at risk of depression.

Please join us in welcoming her to this new role. 

Dr. Lucille Schacht Retires After Nearly 22 Years With NRI

August 5, 2021

Lucille Schacht, PhD, CPHQ has announced her retirement. Her last day with NRI will be August 13. As the Senior Director Performance and Quality Improvement and the director of the Behavioral Healthcare Performance Measurement System (BHPMS), Dr. Schacht brought more than 20 years experience working with complex data systems, applying advanced analyses, and creating technical reports and presentations. Her leadership and collaboration will be greatly missed, and we are grateful for the significant contributions she has made. We wish her the best in retirement. 

Glorimar Ortiz, PhD, MS, will succeed Dr. Schacht as Senior Director of Performance & Quality Improvement.

SAMHSA Releases New Behavioral Health Guide for National Minority Mental Health Awareness Month

Released this July in observance of National Minority Mental Health Awareness Month, this Behavioral Health Guide underscores the ways in which the National CLAS Standards can improve access to behavioral health care, promote quality behavioral health programs and practice, and ultimately reduce persistent disparities in mental health and substance use treatment for underserved minority communities. Read more.  

Oregon Legislature Passes Many New Investments in Behavioral Health

July 22, 2021

Oregon state legislators made systemic changes to health care this session, including a $474 million for the state’s behavioral health system. Of that, $130 million will boost housing and residential treatment for people with behavioral health needs. As well, $80 million will be made available for incentives to increase Oregon’s behavioral health care workforce. This includes programs such as scholarships and grants for providers to offer supervised clinical experience so professionals in training can qualify for licenses to practice psychology, marriage and family therapy, professional counseling and clinical social work. Learn more.

NAMD Executive Director and NRI Board Member Discusses Medicaid's Critical Role During Pandemic on C-SPAN

Matt Salo, National Association of Medicaid Directors (NAMD)'s executive director and NRI Board Member, recently appeared on C-SPAN’s live television broadcast of Washington Journal. During the segment, Matt discussed the critical role Medicaid has played – and continues to play – in providing access to health care during the pandemic. The segment can be viewed here

NRI Board Member Dr. Miriam Delphin-Rittmon Confirmed as Assistant Secretary for Mental Health and Substance Use, Department of Health and Human Services

July 8, 2021

Connecticut Department of Mental Health and Addiction Services Commissioner and NRI Board Member, Dr. Miriam Delphin-Rittmon was confirmed as the Assistant Secretary for Mental Health and Substance Use, Department of Health and Human Services (SAMHSA). Read more.  

NRI Board Member, Dr. Ron Manderscheid Retires from NACBHDD

Dr. Ron Manderscheid, NRI Board Member, has retired from his position as President and CEO at National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD). Recently, he reflected on NACBHDD’s progress and evolutionsince he took the reins in December 2009. 

Health Disparities Among Criminal Justice-involved Older Adults: Current Research and Future Directions

Dr. Jennifer Bronson, NRI Senior Director of Consulting and Research, is a guest editor of a special issue of the International Journal of Prisoner Health. They are accepting paper submissions on Health Disparities Among Criminal Justice-involved Older Adults until August 1. Full submission details are available

Youth Mental Wellness

A PBS episode of Healthy Minds with Dr. Jeffrey Borenstein from 2019 that features Dr. Ann M. Sullivan, commissioner of the New York State Office of Mental Health and NRI Board Member, who discusses mandated state education programs and new tools including a crisis text line. Watch now!  

Indicators of Mental Health Problems Reported by Prisoners

June 10, 2021

NRI Senior Director Jennifer Bronson, Ph.D was a co-author on a recently released statistical report on mental illness among adults in prison. Data showed that 43% of state prisoners had a history of a mental illness and 14% reported past 30-day serious psychological distress. Read the full report

Suicide and Serious Mental Illness

People who live with serious mental illness (SMI)—such as major depression, bipolar disorder, and schizophrenia—are at increased risk of suicide. It is critical to understand the problem of suicide for those who have SMI. That is the only way to create a comprehensive, effective suicide prevention plan.

SMI Adviser and the Suicide Prevention Resource Center (SPRC) present a new guide on Suicide and Serious Mental Illness. It is an ideal resource for both suicide prevention coordinators and mental health clinicians. The guide provides an overview of considerations and suicide prevention measures at the intersection of suicide and SMI. NRI has been working with SMI Adviser since its inception to identify educational needs and develop materials to fill knowledge gaps.

NRI Welcomes New Board Members

May 27, 2021

The NRI Board of Directors is excited to announce the addition of the following two new board members. Their expertise and insights in behavioral health will be greatly valued.

  • Wendy Morris, MSN, Commissioner at Kentucky Department for Behavioral Health Developmental and Intellectual Disabilities.
  • Stephanie Woodard, Psy.D., Nevada State Mental Health Authority and the Single State Authority for Substance Abuse

The Board also wishes to give a big thank you to outgoing board members, NRI Past President, Dr. Lorrie Rickman Jones, and Member-at-Large, Joyce Allen, MSW for their tremendous service. See all NRI Board of Directors.

New Network Collects Real-Time Data To Improve Treatment of Early Psychosis

The National Institute of Mental Health’s Early Psychosis Intervention Network (EPINET) aims to be a “learning health care network” continuously improving the care of patients with first episode psychosis (FEP).

NRI is working with NASMHPD and Westat to support the NIMH-funded Early Psychosis Intervention Network (EPINET). On June 2, NRI will host a webinar to provide more information for state agencies about EPINET and the Core Assessment Battery (CAB), and how your state's Coordinated Specialty Care programs can join EPINET to streamline your outcome monitoring and align with national efforts. Mihran Kazandjian of NRI will discuss updating a national Snapshot of existing CSC programs, and David Shern, PhD, past president and current member-at-large of NRI's Board of Directors and Senior Public Health Advisor at NASMHPD, will chair the webinar and facilitate a question and answer session. Register now.

Improving Tobacco Cessation with Adult Inpatient Psychiatric Clients

May 13, 2021

On Wednesdy, May 19, NRI's Lucille Schacht, PhD, CPHQ, Glorimar Ortiz, PhD, and Missy Rand, LPC, CSAC will present at a Smoking Cessation Leadership Center's webinar Improving Tobacco Cessation with Adult Inpatient Psychiatric Clients. The webinar aims to examine the basic framework of the tobacco use and treatment measures developed by The Joint Commission and used by CMS. Register now.

NRI Board Member, Miriam Delphin-Rittmon, Nominee for Assistant Secretary for Mental Health and Substance Use, Department of Health and Human Services

April 29, 2021

NRI Board Member, Dr. Miriam E. Delphin-Rittmon has been nominated by President Biden for Assistant Secretary for Mental Health and Substance Use, Department of Health and Human Services.

Dr. Miriam E. Delphin-Rittmon is currently the Commissioner of the Connecticut State Department of Mental Health and Addiction Services. She was appointed in March 2015 and previously held the positions of Deputy Commissioner, Senior Policy Advisor, and Director of the department’s Office of Multicultural Health Equity. In her role as Commissioner, Dr. Delphin-Rittmon has been committed to promoting recovery-oriented, integrated, and culturally responsive services and systems that foster dignity, respect, and meaningful community inclusion. In addition, through her 20-year career in the behavioral health field. Dr. Delphin-Rittmon has extensive experience in the design, evaluation, and administration of mental health, substance use, and prevention services and programs has received several awards for advancing policy in these areas. Most recently, she received the 2019 State Service Award from the National Association of State Drug and Alcohol Directors and the 2016 Mental Health Award for Excellence from the United Nations Committee on Mental Health. 

Bureau of Justice Statistics Publishes Three Briefs About Prison Inmates Co-Authored by NRI Researcher

April 15, 2021

Jennifer Bronson, NRI Sr. Director of Consulting and Research, is a co-author of three newly released Bureau of Justice Statistics (BJS) statistical briefs. The topics include disabilities among adults in prison, veterans in prison, and children of incarcerated parents. Findings from the disability report that showed that a cognitive disability was the most frequently reported disability (23%) among people in prison. An estimated 25% of state prisoners reported having ever attended special education classes and 26% reported that they had an attention deficit disorder. Dr. Bronson brings her extensive knowledge of correctional research and data into her role as Director of NRI’s Criminal Justice/Mental Health Research Center.

NRI’s Report on the Experiences of States Implementing Crisis Bed Registries to be the Focus of a Two-Part Webinar Series 

April 1, 2021

The SAMHSA-sponsored, two-part webinar “Improving Access to Behavioral Health Crisis Services with Electronic Bed Registries” will be held on Tuesday, April 13 from 2:00 to 3:30 p.m. (ET), with a 60-minute follow-up discussion scheduled for Friday, April 16th at 2:00 p.m. (ET). Dr. David Morrissette, NRI Consultant, and Ted Lutterman, NRI’s Senior Director of Government and Commercial Research are the featured speakers. Register now

NRI and NASMHPD Develop Needs Assessments on Technical Assistance and Education

SMI Adviser released three survey summarieson state-level needs around technical assistance and education. The surveys were fielded in 2019 by the National Association of State Mental Health Program Directors Research Institute (NRI), in partnership with NASMHPD. The audience included State Mental Health Authority (SMHA) Medical Directors, State Psychiatric Hospital Directors, and First-Episode Psychosis (FEP) Programs. Survey questions addressed topics such as the use of clinical practice guidelines, evidence-based practices, training needs, and more.

Medicaid Forward: Behavioral Health Framework

March 18, 2021

This framework, crafted by an Executive Working Group of Medicaid leaders and national behavioral health experts convened by the National Association of Medicaid Directors (executive director, Matt Salo, is on the NRI Board of Directors), offers states options to consider to promote the health and wellbeing of members and expand access to behavioral health services. Learn more

Save Lives by Prioritizing Individuals with Schizophrenia for COVID-19 Outreach and Education

The University of Michigan completed research highlighting a startling statistic about individuals with Schizophrenia and their odds of dying from COVID being right behind age. In a cohort of people with COVID-19, a Schizophrenia-spectrum diagnosis was associated with more than double the odds of dying, according to new research published in the Journal of the American Medical Association. The fact sheet highlights  the importance of including individuals with Schizophrenia in high priority groups for receiving COVID vaccinations and  discusses barriers and potential solutions in Michigan.

History of Mental Illness Associated With Earlier Signs of Aging

March 4, 2021

Individuals with a history mental illness are more likely to show signs of aging by age 45—including cognitive decline and loss of motor coordination—than are people without such a history, according to a report published in JAMA Psychiatry.

The study may provide insights to the elevated mortality risk experience by individuals with mental illness. It presents a new perspective on early aging among individuals with mental disorders by looking at biological factors and cognitive functioning. It is already known that persons with mental illness die earlier than persons in the general population and that they die mainly due to suicide, however chronic diseases have also been found to be the underlying causes of death.

NRI recently investigated the mortality status of the persons served by the Michigan Department of Health and Human Services (MDHHS) from SFY 2008 thru SFY 2013 and the findings confirmed the excess mortality among the served population. Individuals served by the MDHHS had significantly lower age at death (59 years) than individuals in the Michigan general population (76 years). The casual relationship between mental disorders and the biological aspect of aging may be one possible link for the prevention of premature mortality among this population group. Learn more.

Smoking and Risk of Negative Outcomes Among COVID-19 Patients: A Systematic Review and Meta-Analysis

February 18, 2021

This study notes the increased risk for Serious Mental Illness (SMI) populations who disproportionally have histories of current and former use of tobacco for Covid severity and mortality from it. Read the study.

NRI partnered with the Smoking Cessation Leadership Center (UCSF) to provide training and resources for psychiatric in-patient facilities to improve tobacco cessation treatment through the point of discharge planning.  These free products focus on clinical interventions and system changes that may improve the quality of care for patients.

NRI Board Presiden Named By Michigan Supreme Court to ‘Justice for All’ Commission

February 4, 2021

NRI Board President and Michigan Health Endowment Fund Senior Fellow & Program Officer Lynda Zeller has been appointed by order of the Michigan Supreme Court to the newly-created Justice for All (JFA) Commission that will work toward the goal of 100 percent access to our civil justice system. The Commission will lead the implementation of the JFA Strategic Plan aimed at helping more Michiganians solve civil legal problems such as landlord-tenant issues, family law disputes such as parenting time or custody, and access to benefits. Learn more.

NRI's Ted‌ ‌Lutterman‌ ‌on‌ ‌How‌ ‌Comprehensive‌ ‌Crisis‌ ‌Services‌ ‌Registries‌ ‌Are‌ ‌a ‌Vital‌ ‌Part‌ ‌of‌ ‌the‌ ‌Crisis‌ ‌Continuum‌

January 21, 2021

People in psychiatric crisis are often stuck in emergency rooms for hours or days waiting for placement, says Ted Lutterman, senior director of government and commercial research at  NRI. In other cases, there’s nowhere for them to go. Or worse, there are openings but no systemized way to find out where. The answer, says Lutterman, is a robust crisis continuum and a real-time comprehensive crisis services registry that helps match people to the appropriate level of services they need when they need them. Read more.

NRI and NAMHPD Work with National Data Coordinating Center for the Launch of Early Psychosis Intervention Network (EPINET)

By: David L. Shern, Ph.D. NASMHPD Senior Public Health Advisor; and Steven Adelsheim, MD, DFAACAP, DFAPA, Director, Stanford Center for Youth Mental Health and Wellbeing. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine

The National Institute of Mental Health (NIMH) launched the Early Psychosis Intervention Network (EPINET), a national learning health care system that links early psychosis clinics through standard clinical measures, uniform data collection methods, data sharing agreements, and integration of client-level data across service users and clinics. The EPINET initiative includes 8 Regional Hubs, 101 early psychosis clinics across 16 states, and the EPINET National Data Coordinating Center (ENDCC). The ENDCC is operated by Westat, and serves as the primary coordinator for EPINET activities across the Regional Hubs and early psychosis clinics. Read the full announcement.

For more information, including a list of all participating hubs and clinics, visit the ENDCC website at

CDC Reports Highest Number Of Drug Overdose Deaths Ever In A Year

January 7, 2021

The Centers for Disease Control and Prevention is reporting the highest number of overdose deaths ever in a 12-month period. Read more.

SAMHSA’s Behavioral Health Workforce Report

According to the 2019 National Survey on Drug Use and Health (NSDUH), 80% of individuals with a substance use disorder (SUD) do not get needed care; 57% of those with mental illness also do not get needed care and fully one-third of those living with serious mental illness do not get the care they need. Read more.

Mental Health of the Health Care Workforce During COVID-19 and the Disproportionate Impact on Communities of Color

December 17, 2020

On Monday, December 14, NRI’s Senior Director, Government & Commercial Research, Ted Lutterman presented as part of the third workshop sponsored by the National Academies of Sciences, Engineering, and Medicine’s Forum on Mental Health and Substance Use Disorders. Mr. Lutterman presented results from NRI’s survey on the Impact of COVID-19 On State Mental Health Agency Systems.

The COVID-19 pandemic has created both short-term and long-term negative consequences for behavioral health outcomes. The National Academies of Sciences, Engineering, and Medicine's Forum on Mental Health and Substance Use Disorders hosted a free public virtual workshop: Mental Health and Substance Use Disorders in the Era of COVID-19: With a Special Focus on the Impact of the Pandemic on Communities of Color. The virtual workshop was held via three webinars on November 23, December 3, and December 14, 2020.  

The workshop featured invited presentations and panel discussions on:

  • The epidemiology of mental health and substance use disorders during the COVID-19 pandemic in the overall population as well as a specific focus on the impact of the pandemic on communities of color
  • The impact of the COVID-19 pandemic on access to health care and the delivery of services for people with mental health and substance use disorders, particularly in communities of color
  • The behavioral health impact of the COVID-19 pandemic on the health care workforce, and it’s influence on access to services for mental health and substance use disorders, particularly in communities of color

Recordings of the webinars and slides and additional information from all three of the workshops are now available.

NRI, in collaboration with the National Association of State Mental Health Program Directors (NASMHPD), surveyed the SMHAs during the summer of 2020 to understand and assess the magnitude of the Impact of COVID-19 on State Mental Health Systems. The NRI report is available on the NRI website.

Crisis Services: Meeting Needs, Saving Lives

December 17, 2020

2020 TAC Papers on Mental Health Crisis services authored by NRI Senior Project Associate, Kristin Neylon and Senior Research Associate, Robert Shaw were included in a new book published by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The book, Crisis Services: Meeting Needs, Saving Lives is composed of SAMHSA’s “National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit” and related papers on crisis services. The toolkit reflects relevant clinical and health services research, review of top national program practices and replicable approaches that support best practice implementation.

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, also contributed to the book.

Using Technology to Improve the Delivery of Behavioral Health Crisis Services in the U.S

December 3, 2020

Kristin Neylon, Senior Project Associate at NRI, authored this paper during the summer of 2020 as part of an 11-paper series for NASMHPD on the delivery of behavioral health crisis services in the U.S.  Many technologies exist that can be used to facilitate and enhance the delivery of crisis services, and the importance and promise of technology in the delivery of crisis services has never been more relevant than in 2020 when the world is adjusting to the effects of a global pandemic that limits face-to-face interventions, isolates individuals from their natural support systems, and heightens anxiety due to fear and uncertainty. To understand these issues, and how states are leveraging technologies to enhance services, Ms. Neylon conducted a review of the literature and interviewed representatives from state, local, and non-governmental organizations in Alaska, Colorado, Nebraska, New Mexico, Tennessee, and South Carolina. Read the report.

Understanding Health Reform as Justice Reform

November 12

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.

Tobacco Cessation: Strategies for Improvement

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.

Where Are the Psychiatric Beds in a Community?

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 protected] 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.

APA and NASMHPD Resources for Caregivers of Seniors and SMI Patients

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.

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.

A 2019 Multiple-Paper Follow-up to the Beyond Beds Series Now Available

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

NRI Board Member Highlights Mental Health Resources in New Public Health Course

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.



NRI is Creating a 2020 State Mental Health Profile System – SMHA Information Sought

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 [email protected] 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

NRI/SMI Adviser Survey on Technical Assistance Needed by State Mental Health Agency Medical Directors, State Psychiatric Hospitals, and and Coordinated Specialty Care Providers

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.