From NRI's State Mental Health Agency Services Research, Program Evaluation and Policy in DC, Understanding State Mental Health Agencies, Ted Lutterman & Bernadette Phelan (NRI).
State mental health agencies
Agencies provide services, public health, and public safety.
There has been a shifts in organization with reductions in the number of states with a separate department (19-13 1981-2007) and fewer linked directly to the governor. This is important because the closer to the governor the more resources are available.
Most states (26) have MH and ADA in the same agency. This has increased since the 80s. Most directly fund agencies (28) but many fund counties/cities (16) which adds another level of government to the provision of services.
In 1954 there wee 354 state hospitals with 550,000 residents. In 2007, 228 hospitals with 50,000 residents. The size of hospitals dropped in the 60s and 70s but hospitals themselves did not start closing in large numbers until the 90s.
In 1979 1 our of 3 hospital beds were psychiatric. In 2007 1 out of 7 is psychiatric. These decreases have lead to shortages of acute psychiatric inpatient capacity with increase ED treatment, long treatment waits, overcrowding, etc. States have been addressing this by trying to increase programs to keep folks in the community.
Many states are working to decrease service fragmentation by working with various other state agencies (housing, employment, juvenile and criminal justice, etc.
Most states have mental health courts or diversion programs (43).
Public mental health agencies treat 2% of the population with 96% of those being treated in the community. Almost half of these are not in the workforce and most live in private residence (76%). Most of those (75%) treated are seriously mentally ill.
Over time there has been no improvement in terms other the number who return to the hospital within 30 days (9%) or after 189 days (20%). [Interesting that with the increases in treatment effectiveness that this has not changes. Though it may be related to the fact the the number of individual served has decreased so that those in the hospital will likely have more difficulties.]
There has been a shift in funding from state funds to medicaid. with 45% currently coming from the latter.
Other state agencies
MH services are also provided by other state agencies. NRI is looking to see if they can get information from these other agencies so that they can better understand what states are doing for mental health. Sending letters from the state MH agencies and identifying where they can find the answers to the questions.
NRI has no data to report because they need to get the appropriate clearances (will report at the next year's conference).
While the states and agencies are interested in this there are challenges in getting the data. Agencies may not record data in an obvious way. For example states working with education counted all of the $s spent on special education as mental health services.
Note that all of the data they report is publicly available.