Mental Health Bulletin

Published by
the Montana Mental Health Association
An Affiliate of the National Mental Health Association

EXECUTIVE DIRECTOR'S LETTER

Are these exciting times to be involved in mental health, or what? I just returned from the annual conference of the National Mental Health Association. It was great to to have the opportunity to witness the involvement of consumers and to learn of the many additional supportive services that have been developed through the consumer movement. It should not have come as a surprise to me, the National Mental Health Association was started by Clifford Beers, a consumer.

Although much remains to be done and the need for services and funding is ever present, a great deal is happening. More states are passing laws to get mental health insurance coverage closer to equality with coverage for physical illness. Recent attempts to weaken the Americans with Disabilities Act are being met with stiff opposition from consumers and supportive elected officials. Some community support services are reaching out to consumers where they live, and consumer/survivor self-help groups are being developed in more communities. Individuals are making financial contributions through workplace giving, dinners, raffles, auctions and other events like we have not seen since the very early days of the mental health movement.

I returned from the National Meeting with a lot of information and no more time to get things done than when I left, so, help is needed to accomplish the following two projects: MHVEP and SA groups.

Mental Health Voter Empowerment Project

MHVEP is a non-partisan civil rights initiative working to promote empowerment of mental health consumers and survivors and ex-patients by encouraging them to exercise their right to vote. MHVEP registers voters and enrolls them as project members. As members, voters receive educational material, reminders of upcoming elections, and the opportunity to participate in a variety of activities designed to facilitate voter turnout. MHVEP is about getting out to vote people who understand the need for change in the mental health care delivery system, and the stigma and prejudice that engulfs people living with mental illnesses.

MHVEP was started by consumer activist Ken Steele in New York State and is being expanded to include other States. Technical assistance and consultation is available from the Project.

We have a packet of information and a video that will be made available to any one who is willing to start such a project. Just call 1-800-823-MHAM. See www.ncstac.org for more information.

Schizophrenics Anonymous

Like Alcoholics Anonymous, S.A. has a program of recovery that intends to help members rise above their illness. It is organized and managed by persons with the illness. By applying S.A's six recovery steps, members are called to forgive themselves and others, to reject misconceptions, acknowledge spiritual values, and make other affirmative efforts.

At an S.A. meeting, all members are invited to share their experiences, feelings, and hopes in a confidential and non-judgmental environment. There are no dues to attend meetings, and anyone who wishes to recover from a schizophrenia-related illness is invited.

If you are interested in starting a local SA chapter, please contact our office. We may be able to assist with the initial organization, materials and training. See www.sanonymous.org for more information.

Sibling Study

The Clinical Brain Disorders Branch of the National Institute of Mental Health is seeking family volunteers: one or more biological siblings who have a brother or sister with schizophrenia together with the sibling who has schizophrenia and, if possible, parents of participating siblings. Every participating sibling will receive a stipend and parents will be compensated for their participation. NIMH will assist with transportation and lodging expenses.

Contact: Sibling Project Coordinator, NIMH, Building 10, Room 4S241A, 10 Center Drive, MSC 1377, Bethesda, MD 20892-1377, Phone 1-888-674-6464.

MAZUREK LISTENING TO DISABILITY ADVOCATES

The Americans with Disabilities Act (ADA) is being attacked on many fronts. In one of the most recent challenges accepted by the Supreme Court, Garrett v. University of Alabama, the Court will decide whether Congress had the constitutional authority under the Fourteenth Amendment to enact Title II of the ADA, the section of the law which prohibits discrimination by state governments and allows individuals to sue the state in Federal Court. States are lining up on either side of this classic case of state's rights v individual civil rights. An amicus brief written by the attorney general in the state of Hawaii has been filed in support of Alabama's position, and a Minnesota brief has been drafted in support of ADA covering state governments. Currently, Montana's Attorney General, Joe Mazurek, is considering whether to sign onto the Minnesota brief.

"The ADA is as important to the lives of persons with disabilities as the Civil Rights Act of 1964 is to persons of color," stated Michael Regnier Chair of the Governor's Advisory Council on Disability in a letter to Attorney General Joe Mazurek. In the letter Chairman Regnier asked the Attorney General to (a) sign on the Minnesota amicus brief that supports the constitutionality of the ADA; (b) consult with disability leaders in Montana, including the Governor's Council; (c) join with the disability community across the State in renewing the pledge to support ADA; and (d) hold a press conference to publicize his pro-ADA position in this case.

Mazurek met with Regnier and other members of the disability community on June 9 to discuss his position on the Hawaii brief. After a thorough review of the Hawaii brief in mid-June, the Attorney General notified those who had been present at the June 9 meeting that Montana would not be signing on in support of the Hawaii brief. This is good news because Montana has joined on similar briefs in the past.

Mazurek recently received a draft of Minnesota's brief and forwarded it to the Governor's Advisory Council on Disabilities and other disability leaders across the state. He met with disability leaders on Monday, July 24, to discuss whether Montana should join in with other states and sign onto the Minnesota brief. To those present at that meeting he expressed his concerns about signing that brief and said he would make his decision following further discussions with his legal council, the Governor, and the Department of Public Health and Human Services. Mazurek had until August 7 to decide what Montana's position will be. As the newsletter was going to print, we learned that the Attorney General decided NOT to join the pro-ADA Minnesota brief.

BELL RINGERS WANTED

If you are a person who will respond to requests to write letters, send emails, or make phone calls, MMHA wants you. From time to time issues arise that require immediate attention. When the need for education or advocacy emerges, the Association will email an alert to its list of "Bell Ringers" describing the situation, and it will be up to each "Bell Ringer" to determine his or her response to the "alert." If you have email capability and want to be included on the list, just send an email message to mmha@in-tch.com" Please indicate whether you are interested in children's issues, adult issues, or both.

Health Care Delivery to Inmate Populations Project
Montana State University Bozeman
College of Nursing, Great Falls Campus
Sharon Howard, RN

January 1998, the College of Nursing entered into a contractual relationship with Cascade County to deliver primary health care services to the inmates housed within the new Cascade County Adult Detention Center. The signing of the contract was the culmination of several years of advisement by a Montana State University nursing faculty member to the Sheriff's department related to the responsibility of providing health care to the incarcerated, who are the only population with a constitutional right to health care.

The College of Nursing implemented a holistic nurse- managed clinic at the structure to ensure that health care occurred on site. Complex health conditions would be case managed, a network of specialists would be developed to work collaboratively with the health care staff and all members of the staff would become partners in the cost containment process. Within the holistic health care structure, mental and physical problems are managed through a team approaching care alternatives and planning.

The Project has completed two years of health care system refinement, monitoring for quality outcomes and cost effectiveness. The original structure of the model projected that physical health would place the greatest demands on the resources of the health care system. However, mental health needs, including the care of severely mentally ill, have surfaced as a demanding and persistent problem within this regional jail. Adjustments in the health care delivery model have been made to accommodate the volume and degree of mental health care needs of inmates.

The Cascade County Adult Detention Center houses approximately 350 inmates a day. The population is composed of county, federal, and state inmates ranging in age from 17 to 72 years, with Caucasian, Native American, Hispanic and Black races represented. Women occupy only one in twelve housing units with an average daily census of twenty-four females.

The health care staff consists of master's prepared nurse clinicians with specialty practice in family practice, mental health, community health and administration, baccalaureate prepared nurses, a medical records librarian and assistant. Contracts for service in the specialty areas of psychiatry, forensic psychology (through the University of Great Falls) and internal medicine compliment the primary health care service model.

In addition to this contract providing an opportunity for the development of an innovative practice site for nursing faculty from Montana State University, the site provides teaching and research/creative opportunities for students enrolled in nursing and psychology. It has proven to be a rewarding partnership between county and state entities.

For additional information on this innovative approach to the care of incarcerated persons with a mental illness, attend the September 14th conference at the Holiday Inn-Helena: Mental Illness in Our Criminal Justice System.

Involuntary Treatment
National Mental Health Consumers' Self Help Clearinghouse

Background
Perhaps the most controversial and divisive issue in the mental health community - including among family groups, providers, consumers/survivors, and citizen advocacy groups - is whether people diagnosed with mental illness should be treated, or even held in "custodial" care, against their will.

Involuntary treatment is extremely rare outside the psychiatric system, allowable only in such cases as unconsciousness or the inability to communicate. Mental health consumers, on the other hand, even when they vigorously protest treatments they do not want, are routinely subjected to them anyway, on the justification that they "lack insight" or are unable to recognize their need for treatment because of their "mental illness."

On one side are those who would outlaw the use of force and coercion completely because forced treatment opens the door to abuse and dangerous interventions, creates distrust and avoidance of even voluntary treatment, violates basic civil and constitutional rights, and erodes self-determination, which is essential to recovery.

Individuals on the other side of the issue run the gamut from those who believe that coercion is justified under extreme circumstances - when a person is demonstrably dangerous to himself/herself or others - to those who believe that commitment laws should to expanded to allow force based on a broad and subjective range of criteria.

Consumer/Survivor Viewpoints
There is common feeling in the mental health consumer movement that force and coercion are indicative of failed treatment, are generally harmful and counterproductive, and should be avoided. Within these parameters, there is some disagreement. Some believe that no one should ever be committed against their will, and that "involuntary treatment" is an oxymoron. Others believe that people may be held against their will under extreme circumstances to prevent them from doing harm to themselves or others, but only based on behavior demonstrating an immediate threat of such harm. Many of the latter group believe that such involuntary intervention must consist only of custodial care.

The mental health consumer movement appears to be united in its opposition to outpatient commitment, which involves forcing people with psychiatric diagnoses who are living in the community to accept mandatory treatment, including forced drugging. This is ordered under threat of inpatient commitment if the individual does not comply.

At the National Summit of Mental Health Consumers and Survivors, a group meeting as the Force and Coercion Plank reached consensus that everyone there opposed expanding forced treatment, including involuntary outpatient commitment. Consensus was reached on the following:

• Outpatient commitment would not be necessary is there were appropriate community services available;
• Forced treatment drives people away from seeking voluntary treatment;
• Studies have shown that outpatient commitment has no positive value; what does make a difference is getting appropriate services;
• It is cheaper to put money into community services that to put it into the enforcement of outpatient commitment laws;
• People diagnosed with mental illnesses should have a voice in their own treatment;
• Choice is essential for recovery; and
• Using violence as an argument for expanding forced treatment and outpatient commitment is wrong; every study shows that, absent drugs and alcohol, people with mental illness are no more violent than any other group of people.

In the State Legislatures

In 34 states, laws permit some type of involuntary commitment: Alabama, Delaware, DC, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wyoming.

• Maryland: In February, advocates were able to defeat pending IOC legislation in favor of updating advance directive legislation so that it would better apply to people with psychiatric disabilities.
• Iowa: Although Iowa already has an outpatient commitment statute, an attempt was recently made to pass another, but the bill was defeated.
• Massachusetts: Two outpatient commitment bills were filed last year. One bill, supported and written by AMI members, would change the standards and procedures for civil commitment; a second, more limited bill, filed by the state mental health department, would create conditional discharge for people in mental hospitals after a finding of "not guilty by reason of insanity" or incompetence to stand trial.
• California: Advocates who have been opposing a California bill (AB1800), which expands involuntary outpatient commitment (IOC), seem to have won a victory for the time being. The subject matter of AB 1800 has been referred to a Committee that does not deliberate on bills. Senator John Burton, Chair of the Rules Committee, was quoted in the LA Times as saying, "It (AB 1800) ain't going to happen."

Copies of the adopted planks of the National Mental Health Summit of Consumers and Survivors are available from MMHA on request. The Planks include: financing, recovery, social responsibility, alternative services, forensic issues, force and coercion, advocacy, organizing, multicultural issues, support systems, stigma and research.

Dr. Donald Harr and Jim Johnson Honored

New MMHA Board Members

At the annual meeting of the Association, five new members were seated on the Board of Directors. The new directors include: Marlene Tocher, Great Falls; Candy Wimmer, Helena; Debra Wetsit, Billings; Jolene Goodover, Great Falls; Joan Trost, Great Falls; and Torian Donohoe, Missoula.

THANK YOU TO OUR MANY SUPPORTERS

Our sincere appreciation is extended to all who continue to give so generously and in so many ways to the Montana Mental Health Association. Our volunteers give their time and resources, businesses give in-kind services, corporations and community organizations contribute capital resources, and we appreciate and value greatly each individual and family member of the Association. Following are new or renewed supporters from February 1st to August 1st, 2000. If we have missed your contribution, please accept our apologies, and notify us, so we can make the correction.

Benefactor:
Alternative Youth Adventures
Culbertson Community Fund
Dr and Mrs Donald Roberts
Harris and Eliza Kempner Fund
Judith Birch
Rev Bob and Marjorie VanderAarde
Rose Laslo Pratt
Yellowstone Boys and Girls Ranch

Patron:
Lowell and Susan Bartels
Tom Daniels
Tom and Betty DeYoung
Torian Donohoe
Brian Garrity and Madalyn Quinlan
Barbara Kriskovich
Andrea Merrill-Maker
Margaret Murphy
Alan and Nancy Nicholson
Marilyn and John Olson
Bill and Jeanne Porter
George Selover
Michael Silverglat, MD
Gary Spaeth
William Warfield

Corporate:
Action Print - Helena
Capital Financial Advisory - Helena
Gagnon's Duplicating - Helena
Granite Mountain Bank - Butte
Placer Motors - Helena

Organizational:
Bitterroot Valley Educational Cooperative
Eunice Ash
Glacier County Mental Health Advisory Board
Helena School District #1
Montana Advocacy Program
Northern Montana Hospital
Opportunity Industries, Inc.
Rimrock Foundation
St. Patrick's Hospital
Tasha Hopson

Professional:
Sandi Ashley
Susan Bailey-Anderson
Elaine Barrett
Gena Bellante
Dave Bennetts
Barbara Boik
Hugh and Mary Grace Black
Phyllis Bookbinder
Pat Brown
Sandra Bruno
Bob Caldwell, MD
Frank Cardiello
Dr.Tom Carlin
Mary Chronister
Nancy Cobble
Lynn Ehresman
Mary Jane Fox
Fred Griffen, MD
Karen Grigry
Donna Hale

Professional (con't)
Grace Harding
Joan Hays
Virginia Hill, MD
Dana Hillyer
H. Lee Holmes
Pamela Jackson
Sandra Jackson
David Ketchell
Stuart Klein
Bridget Ladd
Diana Longdon
C.A. Korizek-McKenzie
Deborah Malters, MD
Diana Mann
Hillary Maxwell
Janie McCall
Mary McCue
Archie McPhail
Gay Miller
Maggie Moffatt
Claudia Morley
Maria North
Deborah O'Brien
Joyce O'Neill
Robin Owen
Joni Patterson-Croskey
Chris Pazder
Robert Peterson
Lynn Pillman
Cheryl Ronish
Bob Runkel
Russell Sampley, MD
David Schaefer, MD
Leigh Schickendantz-Tudda
Michael Silverglat, MD
Charlotte Sunderland
Barbara Whitton
Marilyn Williamson
Candy Wimmer

Volunteer:
Jamie Gunther
Louise Greene
Leita Cook

MENTAL HEALTH SYSTEM UPDATE

The Mental Health Services Plan is "hemorrhaging," stated Senator Chuck Swysgood, at the July 25 meeting of the HJR 35 Interim Legislative Finance Committee on Mental Health Services. Chairman Swysgood was addressing the committee about the request from DPHHS to shift $4 million from the program's 2001 budget to cover cost overruns in the fiscal year 2000 budget. At the meeting, members of the Committee queried DPHHS Administrators about their proposed cuts in fiscal 2001 to make up the difference.

Mental health advocates, providers and consumers are unhappy with the proposed cuts, and state and local mental health advisory groups established to provide advice to DPHHS believe their advice is not being followed. The August 4 Bulletin from AMDD reads: DPHHS is continuing to reevaluate its list of budget reduction options and hopes to have a revised list soon. The revisions will be based on input received from stakeholders and interested parties as well as internal discussions.

Following are the proposed cuts made public in the Mental Health Budget Reduction Plan and the Association's response to Director Laurie Ekanger of the Department of Public Health and Human Services.

HOSPITAL LICENSED - PATIENTS TO MOVE IN

The new Montana State Hospital at Warm Springs has been accepted by the State and patients will move into their new quarters on August 21st.

DMDA Consumer's Guide

The National Depressive and Manic Depressive Association (DMDA) has published the Consumer's Guide To Depression and Manic Depression. For a free copy, call (800) 826-3632.

Protest Against "Me, Myself, and Irene"

The National Mental Health Self-Help Clearinghouse has joined with other national organizations in protesting Fox Movie Studios' comedy Me, Myself & Irene, starring Jim Carrey. In its storyline and marketing, Me, Myself & Irene perpetuates several stereotypes and myths about schizophrenia. It regularly confuses schizophrenia and multiple personality disorder. The film also reinforces the exaggerated perception that people with mental illness are violent. Most troubling, the movie portrays schizophrenia, its symptoms and treatments as a joke.

Can't Afford Your Prescription Medication?
Free Prescription Medicine is Available to those who Qualify

• If you do not have insurance or a government program that pays for your outpatient prescription medicines . . .
• If the high cost of your Medicine causes you a financial hardship . . .
• You may qualify to enroll in a privately sponsored program. . . .

The Medicine Program was established by volunteers dedicated to alleviating the plight of patients who cannot afford their medication, according to their web page at www.themedicineprogram.com Their mail address is The Medicine Program, Box 515, Doniphan, MO 63935-0515 or you may call them at 1-573-996-7300 Monday through Friday between 8 am and 5 pm.

Mental Health Budget Reduction Plan 2000-2001 Biennium

1. Suspend MHSP Eligibility Through FY 2001. Effective 8/1/00, no new members will be enrolled in the Mental Health Services Plan. Estimated Savings: $2,100,000
2. Stricter Utilization Management. A number of new and revised utilization management activities will be instituted including, but not limited to, revised clinical placement criteria, revised clinical eligibility criteria, increased consideration of alternatives to out-of-home placement, possible service limits on adult services, ongoing retrospective reviews of outpatient services, reviews of eligibility determinations. Estimated Savings: $1,000,000
3. Cancel Frontier Rate Increase. A rate increase for some services in frontier counties (fewer than 6 people/sq. mile) was promised to mental health centers in order to cover higher cost in rural areas. This increase will not be implemented. Estimated savings: $210,000
4. Partial Hospitalization Rate Decrease/Reduced Sites. Partial hospitalization programs will be required to be located at the inpatient hospital site. Rates will be reduced by 25%. Estimated Savings: $ 637,600
5. No Mental Health Provider Rate Increase in 2001. Estimated Savings: $ 250,000
6. Reduce MHSP Financial Eligibility to 120% of Federal Poverty Level. Effective 9/1/00, membership in Mental Health Services Plan will require income below 120% of poverty ($20,460 for a family of four). Eligibility of those with higher incomes will be cancelled as of 9/1/00. Estimated Savings: $2,000.000
7. Require Additional Consumer Co-Pay. A $5 per service co-pay will be required under MHSP for psychology social work, and professional counseling services. Estimated Savings: $ 100,000
8. Move 25 MSH Patients to Community ACT. Alternative services to achieve a long-term patient census reduction at Montana State Hospital will be implemented. Savings are net of implementation costs. Estimated Savings: $ 250,000
9. Make SED and SDMI Medical Necessity Criteria for Mental Health Therapy Services. Require that Medicaid recipients meet the criteria for Severe Emotional disturbance or Severe and Disabling Mental Illness in order to receive Medicaid funded outpatient services. Estimated Savings: $ 400,000
10. MSH Building Delay Contractor Penalty. A penalty has been assessed to the MSH contractor for construction delay. Estimated Savings: $1,070,000

Total Estimated General Fund Savings: $8,017,500

July 21, 2000
Laurie Ekanger, Director
Department of Public Health and Human Services
Box 4210 Helena, MT 59604

RE: Mental Health Budget Reduction Plan

Dear Ms. Ekanger:

This letter is to express the displeasure of our Association with the proposed budget reductions in mental health services. Although, some reduction in services may eventually be required, other options must be pursued first. It is simply "not fair" to expect consumers to make up the deficit. There are two ways to address an over expenditure of funds. One way is to cut services, the other way is to raise more funds. It has been obvious for several years, now, that the mental health system is not adequately funded.

In the mid 90's, some of us were convinced that managed care would provide the opportunity to develop a broader continuum of services to more consumers by reducing "high end" in-patient and residential services and by developing more appropriate community-based prevention and intervention services. The managed care reality is consumers, providers and advocates were forced to accept that a broader continuum of services to more consumers just could not be done with the current funding design. State government and private enterprise have tried and failed.

Because DPHHS sought public input and contracted for expert advise, and because the legislature initiated further action to study managed mental health care and services, and because so much effort was put forth by individuals dedicated to mental health services, we have learned some things in the process. We have a clearer picture of what an adequate continuum of services should include, from the in-home wraparound service designs of the CASSP and PACT projects through intensive community-based crisis intervention and inpatient hospitalization services. We know better, too, the promises made and not fully delivered to persons with a mental disability by the Americans with Disabilities Act, the Vocational Rehabilitation Act and the Civil Rights Act.

The Mental Health Association has been and is currently involved with the Mental Health Oversight Advisory Council, the HJR 35 Interim Committee, the Local Mental Health Advisory Councils, the Office of Mental Health Ombudsman, the Montana Advocacy Program, the Board of Visitors, the Montana Chapter of NAMI, and so many others who are struggling with this issue. We want you to know, too, that we work with and value the staff of the Addictive and Mental Disorders Division. Most of us have played a role in getting where we are today, and it is going to take all of us to get where we want to be tomorrow. It requires a team effort.

Although the Association is lacking in procedural specifics, we do have some understanding of the constraints you are under with the executive and legislative budgeting processes. We know this is the first public announcement of the proposed reduction options, and you are seeking public comment.

We have a problem with the initial approach to meet the shortfall by cutting services and increasing eligibility requirements. It might be that the Department is hamstrung by the supplemental appropriations' procedures and is required to show what services would be eliminated or reduced? But, it is obvious that some of the shortfall could be made up through better use of matching Federal funds across Divisions within the Department. Both the Mental Health Oversight Advisory Council and the HJR 35 Interim Committee have heard options for potential use of Federal funding sources. From the outside, it appears that DPHHS has not thoroughly researched the options presented. We know the Department is looking at funding for children's mental health services through CHIPS. Are there other Federal matching possibilities through increased use of Medicaid options, EPSDT, or other existing programs in the Health Policy and Services Division?

Cutting across Divisions within the Department is complex work. As we all know, when Federal funds are accepted, they come with rules and regulations that must be followed. We have worked with DPHHS staff on these complexities in the past and are eager to do so again. We would all like to have a fully funded mental health service system with general fund dollars, but it is not going to happen. To the extent we can get other funds (and meet the requirements that come with those funds without compromising what we want to do), we need to do it.

Regarding the specifics of the proposed reduction plan:

1. Suspension of MHSP eligibility and enrolling no new members is simply too much to swallow. We feel the impact of this measure would be devastating to the system. The pain and suffering of those individuals who will be sent back to the streets and the criminal justice system for services is unacceptable.
2. We do accept the concept of stricter utilization management. We believe it has been too easy to move consumers to higher levels of service. There must be a gate keeping function to ensure the appropriateness of such moves. Every level of service must be monitored for appropriateness and length of service and be based on progress. If we ever hope to move individuals who have made progress in more intensive services to a lower level of service, we cannot continue to fill the lower level services with consumers who are moving up the ladder of services.
3. The cancellation of the frontier rate increase is a surprising recommendation. The negotiation of the increase took a lot of time and effort and means so much to rural services. Many counties will have reduced or no mental health services if this recommendation is followed. The projected savings are minimal and the impact on rural services so great, this recommendation is totally unacceptable and should not be a part of this or any other budget reduction plan.
4. We cannot comment on the proposed decrease in rates and sites for partial hospitalization without knowing a good deal more than we do now about the impact of this recommendation.
5. We feel the same way about this recommendation to not implement provider rate increases as we do about the frontier rate increase and for the same reasons. See #3 above.
6. This recommendation to reduce MHSP financial eligibility to 120% of the Federal Poverty Level is a tough pill to swallow. As mental health advocates we do not want financial eligibility to be any more restrictive than it is at this time. We need more information on the ramifications of this recommendation. In particular, this recommendation for MHSP need not be this drastic if Federal matching funds could be obtained through TANF or other sources.
7. The proposal to require an additional consumer co-pay appears reasonable at $5 per service, but for those individuals receiving intensive services it would be too much. To protect those requiring intensive services, there probably should be a monthly maximum limit that consumers would have to pay.
8. The proposal to move 25 state hospital patients to the Community ACT program is acceptable and should be done in the regular course of business assuming "appropriateness" of the move.
9. This proposal to serve only the most seriously ill is "penny wise and pound foolish" and will force other systems to become the catch basin for mental health services. Those involved in the development of services for seriously emotionally disturbed youth through the CASSP project worked hard to arrive at what we believed was a workable definition. We do NOT want to go back to where we were in children's services. We believe the definition can work - if the appropriate utilization management system is in place.
10. As advocates for an adequate system of care and services for persons with a mental illness, we are appalled at what took place with the building of the new hospital. We believe the contractor did not know a lot about the differences between physical health and mental health hospitals. The construction delays are not acceptable, however, we do not know enough about the details to comment on the amount that should be reimbursed.

During more than 50 years of advocacy, the Montana Mental Health Association has participated in every major problem and solution confronting services in this state to persons with mental illnesses. We have played an important role in where we are today in mental health services, and we will continue to be involved. Through the combined efforts of all of us, we will get past this current short fall. The current budget reduction plan, however, must be reconsidered.

Sincerely,

Bob VanderAarde, President
Charles McCarthy, Executive Director