Conn., N.H. sustain mental health spending increases

Connecticut and New Hampshire are among 11 states that increased funding for mental health services every year since the 2012 mass shooting at an elementary school in Newtown, Conn., according to a National Alliance on Mental Health report.

Massachusetts and Maine joined Connecticut and New Hampshire in increasing their mental health budgets from fiscal 2014 to 2015, according to NAMI’s report, “State Mental Health Legislation: Trends, Themes and Effective Practices.”

Rhode Island and Vermont were among 14 states that maintained their mental health spending from the previous year.

But less than half of states increased their mental health budgets from fiscal 2014 to 2015.

“We made incremental progress,” said the report’s lead author, Sita Diehl, M.A., MSSW, director of state policy and advocacy for NAMI’s national office based in Arlington, Virginia.

“It was not truly impressive, particularly considering how much mental health has been in the headlines. You would think states would take mental health investment more seriously. There was innovative legislation, but it could have been more impressive.”

Mental health budgets vary so widely from state to state that making exact dollar comparisons is difficult, so NAMI looks at the overall trend of whether spending is up or down, Diehl said.

NAMI issued its first annual review of state mental health legislation in 2013 to guide the efforts of state leaders and advocates during the recovery from a recession in which states cut $4.35 billion from the overall mental health system.

The report highlights mental health legislation passed in each state and awards gold stars to measures considered innovative and potential models for other states.

“The idea behind the report is to make it easy for legislators to do the right thing,” Diehl explained.

Connecticut’s mental health parity legislation S.B. 1085, signed into law by Gov. Dannel Malloy (D), on June 30, 2015, earned a gold star.

Under the law, individual health plans must cover mental or nervous conditions – including general and psychiatric inpatient hospitalization or outpatient services, intensive outpatient services and partial hospitalization – on the same basis as medical, surgical or other physical conditions.

NAMI marks legislation considered ill-informed or discriminatory with a red flag for other states to avoid.

A red flag went to New Hampshire’s defeat of S.B. 185, which would have extended the Dec. 31, 2016, expiration date of the New Hampshire Health Protection Program, a Medicaid-funded health care program expanding coverage to the state’s low-income residents.

New Hampshire is among six states that expanded Medicaid through an 1115 demonstration waiver – issued by the U.S. Department of Health and Human Services to approve experimental programs for low-income individuals who would not otherwise have access to Medicaid.

The bill was tabled last March with bipartisan agreement to resume discussions in 2016. Both the New Hampshire House and Senate are Republican-controlled.

“It needs to be re-authorized,” said NAMI N.H. Executive Director Kenneth Norton, LICSW.

“The Senate has really been the leaders in passing health care expansion in the first place, and they’ve come under some criticism from their own party for having done that. They are very much likely to support it again but convincing the House to do so is going to be a challenge.”

The report cites eight examples of New Hampshire legislation as positive steps for protecting mental health in the state, including S.B. 33, which requires mental health practitioners to receive at least three hours of continuing education training in suicide prevention, intervention, or postvention to renew their license.

That makes New Hampshire one of only a handful of states with such a requirement, and Norton thinks more will follow given research showing master’s level clinicians often do not receive adequate risk assessment training as part of their formal education.

The increase in the state’s overall mental health spending has failed to translate to more dollars for community mental health centers, Norton said.

But, Norton added, New Hampshire is “moving in the right direction with much work to be done.”

NAMI Connecticut Executive Director Kate Mattias MPH, J.D., said her organization spent much of the 2015 legislative period on the defensive even though Connecticut is the only New England state making the top 10 for per capita state mental health services expenditures. Mattias said she anticipated her organization will continue “fighting to hold on to what we have” in 2016.

“This past year was a tough one,” Mattias said, “in so far as the state itself just has some structural financial problems. Under those circumstances, they’re looking for money wherever they can find it. There were some significant cuts that were proposed for social services including mental health services. The advocates in the state really rallied.”

Noteworthy Connecticut legislation enacted included S.B. 1053, which prohibits out-of-school suspensions and expulsions for students enrolled in a preschool program or grades kindergarten through 2, and S.B. 927, which prevents the physical restraint or seclusion of schoolchildren for non-emergency situations and requires teacher in-service training on restraint, seclusion and alternative de-escalation techniques.

Mattias said NAMI Connecticut will monitor the progress of a new task force established to study the state-wide response to minors exposed to family violence. The task force was created by S.B. 303, which was also highlighted in the national NAMI report.

“Overall, Connecticut is in a terrific place. We’ve had terrific leadership when it comes to mental health services in the state,” Mattias said.