Grading the States 2006: Introduction
The National Alliance on Mental Illness (NAMI) presents this state-by state "report card" on adult mental health care systems in the public sector in order to measure closely the continuing crisis in what President Bush's New Freedom Commission on Mental Health has labeled a "system in shambles."
The report is intended as a starting point. It is intended to provide a common baseline that will help the states share, learn, and build from individual lessons and innovations and will help them measure progress in future years. We hope it will give policymakers ideas to use in improving their states' mental healthcare systems. We also hope it will give consumer and family advocates information and the tools they need to shape agendas for change and hold policymakers accountable.
In appointing the New Freedom Commission in 2002, President Bush challenged the nation:
"Our country must make a commitment: Americans with mental illness deserve our understanding, and they deserve excellent care. They deserve a healthcare system that treats their illness with the same urgency as a physical illness…
"Today, new drugs and therapies have vastly improved the outlook for millions of Americans with the most serious mental illnesses, and for millions more with less severe illnesses. The treatment success rates for schizophrenia and clinical depression are comparable to those for heart disease. That's good news in America, and we must encourage more and more Americans to understand, and to seek more treatment."
Today, that promise is stalled and at risk. The mental healthcare system faces continuing financial crisis as well as a need to catch up with advances in science and with proven, cost-effective treatment practices.
The report focuses on state adult systems of care. It does not address systems that serve children and adolescents, older adults, and veterans. That focus, however, should not be interpreted as a disregard for the importance and urgency of their distinctive needs. Much of this report focuses on State Mental Health Authorities (SMHAs), which provided much of the information for the grading process. However, the grade applies not to each SMHA, but to the total system in each state. The nation's overall system is complex and organizationally fragmented. It involves both the federal and state governments; counties and cities; and other public sectors such as the education, social welfare, and criminal justice systems. It is affected by private-sector trends involving medical professions, hospitals, and insurance. It also is financed from many funding streams - a fact which sometimes results in competing priorities and conflicts beyond the control of any one agency.
That said, SMHAs play the most critical role in organizing, coordinating, and implementing statewide systems of services. Their leadership and accountability are vital. At the state level, it is their responsibility and obligation to push the agenda for change.