Creating Dynamic Policy Change in Mental Health

1. Creating Dynamic Policy Change in Mental Health Thomas Bornemann, Ed.D. Director, Carter Center Mental Health Program

2. Outline • Carter Center Mental Health Program • Affordable Care Act: Mental Health and Addiction • Current Issues in Mental Health • Case Study: Georgia’s Mental Health System • Conclusions

3. Carter Center Mental Health Program • Founded in 1982; led by Rosalynn Carter • Active internationally, nationally, and within Georgia • The Rosalynn Carter Fellowships for Mental Health Journalism • Liberia • Public Policy • Georgia

4. Affordable Care Act (ACA) : Behavioral Health • Dynamic policy environment • Milestone in health care policy • Expands preventive services and integration with primary care • Hurdles will arise in implementation but will ultimately greatly expand access to mental health and addiction services • Parity issues

5. Current Issues in Mental Health

6. Current Issues in Mental Health Children and Adolescents • Foster care and adoption services • Comprehensive screenings and routine checkups • Collaborative partnerships with therapists and other invested parties • Support for families who adopt children in the child abuse and foster care system • School-based health centers can provide behavioral health services and early screenings for low-income children • Juvenile Justice reform -National Center for Child Traumatic Stress Network

7. Current Issues in Mental Health Special Populations • Transitional age children • Many mental health disorders begin in adolescence • Providing solid transitional services will prevent young people from exiting the mental health systemprematurely • Community services should include efforts to address disparities in racial minorities, LGBT individuals, developmental disabilities and other populations with unique needs • Veterans and their families • Older adults -

8. Current Issues in Mental Health Policy Issues • Department of Justice settlements in New Jersey and North Carolina and ongoing lawsuit in New Hampshire and other states under scrutiny • From 2009 to 2011, states collectively cut $1.8 billion for children and adults with mental illness (NAMI) • Cuts have reduced mental health services and shifted the burden of first response for people in crisis to law enforcement officers and emergency room physicians • Workforce development

9. Policy Investment in Mental Health • Policy can lead to concrete, measurable results • Nonprofits have flexibility to accomplish policy changes that government agencies and clinicians do not have • Investments in policy can affect large numbers of people, and are potentially sustainable, long lasting, and cost effective

10. Case Study: Georgia’s Mental Health System

11. Case Study: Georgia’s Mental Health System A Hidden Shame: Death in Georgia’s Mental Hospitals Sarah Crider, died at fourteen -Atlanta Journal-Constitution

12. Case Study: Georgia’s Mental Health System GA Mental Health System Under Scrutiny • August 2008—Carter Center Mental Health Program (MHP) gets involved in case against the state of Georgia • January 2009—Conditional settlement reached between Department of Justice and Georgia re: CRIPA • February 2009—MHP and other state and national stakeholders entered as amicus curiae • July 2009—Department of Behavioral Health and Developmental Disabilities created (DBHDD) • January 2010—Second suit filed addressing community services/Olmstead • October 2010—Final settlement addressing both suits finalized • May 2011—Carter Center releases draft of Vision Report • May 2013—Governor signs Juvenile Justice Reform Bill (HB 242)

13. Case Study: Georgia’s Mental Health System Creation of Community Services

14. Case Study: Georgia’s Mental Health System Progress and Results • Complete reform of Georgia’s mental health system in five years despite recession • Georgia mental health services are a model for the rest of the country • Narrow policy intervention led to significant change • Leveraged a community-based crisis system into a community-based treatment system • Learning Collaborative for Integrated Care

15. Case Study: Georgia’s Mental Health System Keys to Success • Investments from local foundations allowed The Carter Center to take a leadership role in the settlement • Strong leadership by the state government • Trust • Engaged all parties - not weighted in any one direction • Transparency

16. Funders for our Georgia Activities • The J. B. Fuqua Foundation (GA Urgent Model Project; C&A due diligence grant) • The Tull Charitable Foundation (GA Urgent Model Project) • The Betty and Davis Fitzgerald Foundation (GA Mental Health Activities – Vision Document regional meetings) • Healthcare Georgia Foundation (Integrated Care, Health Policy) • The John and Polly Sparks Foundation (GA Mental Health Activities)

17. Conclusions • Mental health is a national concern with heavy emotional and financial costs • There are opportunities for investment in multiple areas: children, older adults, trauma survivors, etc. • Investment in policy creates long-lasting, wide spread changes with a high economic and social return on investment

18. Thank you Thomas Bornemann, Ed.D. Director, Carter Center Mental Health Program ccmhp@emory.edu (404) 420-5165