Grading the States 2006: Executive Summary
This report is the first comprehensive survey and grading of state adult public mental healthcare systems conducted in more than 15 years. Public systems serve people with serious mental illnesses - such as schizophrenia, bipolar illness, and major depression - who have the lowest incomes.
The report confirms in state-by-state detail what President Bush's New Freedom Commission on Mental Health called a fragmented "system in shambles."
Nationally, the system is in trouble. Its grade is no better than a D.
Too many state systems are failing
Only five states receive a B: Connecticut, Maine, Ohio, South Carolina, and Wisconsin.
Seventeen states receive Cs, 19 states get Ds, and eight get Fs. That's without the pluses and minuses.
Those states that are failing are: Iowa, Idaho, Illinois, Kansas, Kentucky, Montana, North Dakota, and South Dakota.
This report includes tables that indicate each state's overall grade as well as its grade in each of four categories: Infrastructure, Information Access, Services, and Recovery.
Each state grade is based in part on a "take-home test," in which survey questions were submitted to state mental health agencies during October and November 2005. All but two states responded. Colorado and New York declined. They have been graded "U" for "Unresponsive."
NAMI wishes to commend Alabama, Louisiana, and Mississippi for their participation, which came in the wake of the twin catastrophes of Hurricanes Katrina and Rita.
Based on the surveys and publicly available information, states were scored on 39 criteria. Consumer and family advocates also provided information through interviews that contributed to state narratives.
The "Consumer and Family Test Drive" represents a unique, innovative measurement. Access to services depends on access to information. NAMI therefore had consumers and family members navigate the Web sites and telephone systems of the state mental health agency in each state and rate their accessibility according to how easily one could obtain basic information.
To some degree, this exercise was like a "pop quiz." Over 80 percent of the states scored less than 50 percent of the total points.
In one case, an agency employee told a consumer: "No, I will not help you."
Those states that received excellent Test Drive scores were Indiana, Michigan, Ohio, South Carolina, and Tennessee.
Those that received the lowest Test Drive scores were Alabama, Arkansas, Missouri, New Mexico, and South Dakota.
For each state, grades in each category and scoring of the 39 criteria appear in the "State Narratives" section of the report.
The narratives provide context. Common themes emerge. In every case, they relate to choices. None are predestined. Some reflect choices made by governors and legislatures, sometimes without full appreciation of the nature of serious mental illnesses.
The report offers several basic policy recommendations:
- Increase funding tied to performance and outcomes
- Invest in proven, cost-effective practices (i.e., evidence -based practices)
- Improve data collection
- Increase access to information
- Involve consumers and families in all aspects of the system
- Eliminate discrimination
Each state narrative also includes a list of specific "Innovations" and "Urgent Needs" to help advocates and policymakers further define agendas for action. An overall list of innovations provides an opportunity for states to learn from one another. Just a few include:
- California's Proposition 63 to finance mental health services
- Low-income housing financed by real estate transaction fees in Illinois
- A telephone triage system in jails financed through DWI fines in Kentucky
- A public-private joint venture in Massachusetts to replace a mental health center
- A prescription feedback system in Missouri that has reduced hospitalizations and unnecessary poly-pharmacy
- A purchasing collaborative in New Mexico
Creative action is needed. Progress is needed. As the grade distribution in the report demonstrates, the United States still has a long way to go to achieve a "New Freedom" for people living with serious mental illness - a freedom based on recovery and dignity.