NAMI's Recommendations for States and the Federal Government
5. Increase Services for People with Serious Mental Illnesses Who are Most at Risk
Where We're Failing
In state after state, there are serious shortages of inpatient psychiatric beds and crisis stabilization programs for people with serious mental illnesses. Also lacking are appropriate mechanisms for responding to people with serious mental illnesses whose symptoms may preclude them from recognizing their need for treatment and therefore accessing services.
The cost to states, and the nation, of delayed or inappropriate responses to these individuals is extremely high.
- Many community hospitals have eliminated their psychiatric beds for more profitable alternatives.
- Jails and emergency rooms frequently end up as default providers of crisis care.
Eliminate the "Institutions for Mental Diseases" (IMD) Exclusion
- This longstanding and discriminatory Medicaid provision prohibits use of federal Medicaid dollars for services for people (ages 22-64) in psychiatric hospitals. The IMD exclusion serves as a barrier not only to reimbursing care in psychiatric hospitals, but also to implementing Medicaid reimbursable home and community-based waivers that have been very helpful to other Medicaid populations, such as people with developmental disabilities.
Implement a Coherent Response to Non-Adherence to Treatment
- States should implement a full set of strategies tailored to individuals whose symptoms may preclude them from recognizing that they are ill and thus participating in treatment. These strategies (which are described in Chapter 1 of this report) should include Assertive Community Treatment (ACT) programs, peer supports, Psychiatric Advance Directives (PADs), motivational strategies such as the LEAP program, treatment guardianships, and, as a last resort, court-ordered assisted outpatient treatment (AOT).
Adopt Incentives to Increase the Qualified Mental Health Workforce
- Essentially, the entire country is a mental health services professional workforce shortage area. Without adequate numbers of qualified mental health professionals, the provision of appropriate services to people with serious mental illnesses is impossible. Incentives to increase the mental health workforce, including competitive salaries, loan forgiveness programs for those who commit to service in the public mental health system, and administrative supports to decrease paperwork burdens on front-line mental health professionals, should be adopted.