Grading the States 2006: Ohio - Narrative
Ohio is home to some of the strongest leaders in improving the nation's mental healthcare system, and a pace-setter for states with large county-based systems.
As the state with the electoral votes that decided the 2004 presidential election, it may be no exaggeration to say that in the field of mental health, too, as goes Ohio, so goes the nation.
The director of the Ohio Department of Mental Health (ODMH), Michael Hogan, Ph.D., is one of the nation's longest serving mental health agency heads. He served as chair of the President's New Freedom Commission on Mental Health in 2002-2003. U.S. Senator Mike DeWine and U.S. Representative Ted Strickland have nurtured the growth of mental health courts and criminal diversion programs nationally. State Supreme Court Justice Evelyn Lundberg and Corrections Director Reggie Wilkinson also have forged new policies, programs, and partnerships to change the shape of treatment in the state's criminal justice system.
In addition, consumer and family participants in policy and service decisions within the system play important leadership roles.
Unfortunately, gaps and unmet needs still exist. It is a sad commentary on public mental health systems when even a state like Ohio is still not fully able to bring treatment and recovery to people with serious mental illnesses.
Leaders alone are not enough. Quality services cost money. New funds are entering the Ohio system through a federal Transformation State Incentive Grant (TSIG) and recent budget increases. ODMH received a 3 percent increase in 2005 and again in 2006 - the largest increase for any state department. In a period of intense competition for funds, it was an encouraging signal that Governor Taft and the General Assembly recognize the importance of mental health in the state's overall healthcare equation.
Looking beyond the public health system, Ohio advocates are hoping that the same vision will extend to passage of a mental health insurance parity law. Lackof parity is a strange blot on Ohio's record of national leadership, compared to the 36 other states that have passed such laws.
Parity is important in helping to stem the flow of people with private insurance into the public system - as well as being central to eliminating stigma and discrimination. When middle class families lack mental health benefits under private health insurance plans, they often spend down assets and end up in the public system, or go without treatment. Ultimately, costs are passed on to the state. More emergency room visits and hospitalizations result. In some cases, costs are shifted to the criminal justice system. The legislature's inaction on parity comes with a price.
ODMH plans to use increased funds to maintain current levels of hospital beds and staff, while offering Safety Net Emergency Funds to community service boards, based on financial hardship. Even so, the system presently is overwhelmed by not enough money or staff. There are long waitlists for services and housing. ODMH's support of 27 residency and training programs at state universities are intended to ease the workforce shortage, but by themselves, they aren't enough.
Medicaid funds many services. Federal waivers allow boards to manage provider contracts autonomously, but autonomy comes with a price - they must provide matching funds. Many boards therefore limit investment in services that are non-Medicaid reimbursable, in order to maximize federal funding. The result is minimum access to recovery-oriented services that may not be reimbursable, such as early intervention, housing, employment, consumer-run programs, and culturally competent services. In addition, recent changes in Medicaid eligibility requirements will drop nearly 20,000 adults from the rolls. Taken together, Ohio's toughest challenge will come in finding the funds to sustain services and innovations in the future.
Other states would do well to take notice of Ohio's approach to implementing evidence-based practices (EBPs) and decriminalization of mental illness. Coordinating Centers of Excellence (CCOEs) and Networks, located around the state, instill best practices through a three-phase model of engaging practitioners, providing training in specific EBPs, and offering follow-up reinforcement. The state recently made Assertive Community Treatment (ACT) a reimbursable service under Medicaid. The CCOE approach will allow the state to upgrade intensive case management services using ACT teams.
The commitment of Ohio leaders to criminal diversion and re-entry programs for people with mental illnesses is unique - these successes represent real partnerships that have brought together diverse communities and centers of power. In May 2005, the Criminal Justice CCOE, along with the Ohio Supreme Court, Capital University Law School, and NAMI Ohio, co-sponsored the first national conference on Crisis Intervention Teams (CIT) and the third national conference on Mental Illness and the Criminal Justice System, drawing participants from around the nation.
The challenge for Ohio is to apply the same kind of commitment and cohesion to other dimensions of the mental healthcare system - with the support from the legislature and other community leaders.
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