NAMIGrading the States: A Report on America's Health Care System for Serious Mental Illness
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Grading the States 2006: Innovations

A Sample of State Innovations and Best Practices, as viewed by NAMI

During the development of this report, programs and policies emerged that represented sound examples of innovation and commitment to providing high-quality services to people living with mental illness. They are shining examples of high quality. The following list is not comprehensive, but it demonstrates the pioneering approach that is necessary to change fundamentally America's mental health system. There is an urgent call for our nation to take steps to make these programs the norm - not the exception.


  • Proposition 63 - Voters recognize need to creatively fund services. (California)
  • Combining multiple funding sources to stream-line care and decision-making. The jury is out, but the effort will teach others. (New Mexico)
  • Local municipalities taking the lead to address mental health concern in their communities through special tax districts or unique bond proposals. (Arizona and Colorado)


  • Tremendous progress in developing housing, which rose from almost none in NAMI's 1990 report to among the best today. (Tennessee)
  • Transaction fees on real estate transactions to promote rental housing assistance. (Illinois)
  • Passage of legislation that dedicates $200 million to create 10,000 units of new supported housing in the next 10 years. (New Jersey)
  • Initiative to develop more than 36,000 supportive housing units. (New York)
  • Cooperative ("Bridges") program between the state mental health authority and the housing finance agency to provide $650,000 in housing subsidies for people with serious mental illnesses. (Minnesota)

Restraint and Seclusion Reduction

  • The leadership of the National Association of State Mental Health Program Directors (NASMHPD) drives a national culture change.
  • Significant reductions in use of restraint and seclusion in a forensic setting at North Texas Hospital (Texas) and Taylor Hardin Secure Medical Facility. (Alabama)
  • Regulations enacted in 2006 to codify a preventive approach and discourage the use of restraint and seclusion in all facilities, both acute and state-run. (Massachusetts)

Jail Diversion 

  • A culture of jail diversion that penetrates almost the entire state. (Ohio)
  • Legislation mandating a telephonic triage system to screen jail inmates for mental illness and to provide linkages to treatment. (Kentucky)
  • Extensive post-booking jail diversion programs in arraignment courts. (Connecticut)
  • TAMAR (Trauma, Addictions, Mental Health, and Recovery) Project for the treatment of female consumers in detention centers. The program also helps their children. (Maryland)
  • Prison education program run by NAMI Indiana and supported by the state DMHA and Department of Corrections to educate prison guards and staff about serious mental illnesses. (Indiana)
  • Mandatory jail diversion strategies for every county authorized through HB 2292. (Texas)
  • Statewide implementation of police crisis intervention training (CIT). (Georgia and Texas)

Employment/Vocational Success

  • Five states received excellent scores in NAMI's survey for their work in employment. (Connecticut, Maine, Missouri, New Mexico, and Vermont)
  • A rural state is dedicated to employment opportunities, reporting an impressive 41 percent employment rate for consumers. (South Dakota)

Disaster Response

  • Quick response and triage to continue service provision and ensure safety of consumers during and after Hurricane Katrina. (Mississippi, Louisiana, Alabama, and Texas)
  • Mutual aid support from many states across the country.

Academic/State Collaboration

  • Partnerships with SMHAs and universities to establish centers promoting the implementation of EBPs. (Ohio, Hawaii, and Indiana)
  • Collaboration to promote the mental healthcare workforce with Yale University. (Connecticut)

Creative Use of Public Land

  • Public/private collaboration to rebuild a community mental health center. (Massachusetts)
  • Reinvestment of funds from the sale of a state hospital to create increased housing options for individuals with mental illnesses through the Community Mental Health Housing Fund. (Oregon)
  • Establishment of the Alaska Mental Health Trust Authority to generate revenue for the state's mental health services. (Alaska)

Mortality Studies

  • NASMHPD medical directors are investing in this important issue as a priority.

Multicultural Outreach

  • State leadership to encourage and monitor county-based efforts to ensure culturally competent care. (California)
  • Efforts to ensure the mental health workforce has appropriate linguistic skills, and that materials are properly translated. (Arizona)
  • Establishment of subcommittees - specifically on ethnic/cultural minorities and sexual minorities - to focus on the impact that legislation, public policies, and practices have on the treatment of multicultural and/or minority groups in institutional, residential, and community settings. (Washington)

Co-Occurring Systems Change

  • Development of a consumer- and family-driven process to evaluate every level of the system to integrate services for co-occurring disorders. (Oklahoma)
  • Leadership to integrate treatment for substance abuse and mental illness, resulting in statewide adoption of integrated dual disorder treatment. (Delaware)
  • State-funded program to incorporate mental health treatment principles into a traditional 12-step model, "Double Trouble in Recovery." (Georgia)

Capacity Response

  • Using the state's authority to generate new inpatient beds to address a profound need among the population. (Arkansas)

Best Information

  • Several states score as top performers on NAMI's Consumer/Family Test Drive. (Tennessee, Ohio, Indiana, South Carolina, and Michigan)
  • Several states provide most accessible SMHA Web sites. (South Carolina, Alaska, Minnesota, New York, Tennessee, Texas, Massachusetts, Michigan, Oregon, and California.)
  • Web site publication of a report containing data comparing performance in the provision of mental health services with neighboring states. (Nevada)

Parity Laws

  • Model parity law that includes substance abuse. (Connecticut, Maryland, Minnesota, Vermont, and Oregon - to take effect in 2007)
  • Inclusion of mental health parity in a statewide program to expand health insurance to uninsured populations. (Maine)

Clinical Approaches to Medication Access

  • Program to provide clinical feedback to doctors on prescribing patterns that save money and improve outcomes. (Missouri)

Peer Support/Peer Run Programs

  • A culture infused with recovery principles. (Vermont)
  • Policies to promote recovery and ensure that it is a part of the state's mission and treatment planning. (Connecticut)
  • Medicaid reimbursement of certified peer counselors. (Georgia)

Health Promotion

  • Development of a program that provides identification and intervention for diabetes, hypertension, and other cardiac risk factors among individuals with serious mental illnesses. (New Hampshire)

Community System of Care

  • Comprehensive systems of care with demonstrated linkage between service providers and integrated service approaches. (Vermont and Wisconsin)

Engaging Rural Constituents

  • Use of audiovisual technology to eliminate long-haul vehicle transport for persons in need of emergency orders of detention. (Oklahoma)
  • "Deliberate and Deliberative" approach to system redesign to improve local service capacity and access within specific budgetary constraints. (Nebraska)

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