Research suggests that peer support for persons with serious mental illnesses can improve psychological outcomes, such as empowerment, and can also improve clinical outcomes, such as reduced hospitalization. As of last year, Minnesota is now 1 of 26 states that cover peer support services. With a focus on recovery, the Certified Peer Specialist (CPS) is a compensated and trained member of a mental health services team. According to the Minnesota Department of Human Services website, the role of a certified peer specialist is to:

• Inspire hope that recovery from mental illness is not only possible, but probable
• Provide opportunities for people using mental health services to practice self-efficacy through activities that emphasize the acquisition, development and enhancement of skills needed to move forward in mental health recovery.
• Promote empowerment and self-determination
• Build relationships based on mutuality and shared-perspective
• Deepen the treatment teams’ understanding of the experience of being a mental health consumer.

CPS Training is provided through the the Minnesota Department of Human Services for individuals that work within an Assertive Community Treatment, Intensive Residential Treatment, Crisis Response and/or Adult Mental Health Rehabilitative program.

The Facing Us Clubhouse, a program of the Depression and Bipolar Support Alliance (DBSA), is a free online wellness tool for individuals living with mood disorders. The website offers a variety of tools and resources to help support and maintain a person’s health and well-being. These include:

• Personal online journal where you can write down your daily reflections, do some creative writing or gratitude practice, or other forms of expression.
• A step-by-step individualized wellness plan that helps you take control of your health and well-being.
• Personal wellness book where you can collect and write down tips and advice that work for you, read tips from others, and if you like, share them with family and friends.
• Media room that includes audio and video material to uplift your spirit.
• Creativity center that has online workshops and podcasts to help you be inspired and find your creative outlet.
• DBSA Wellness tracker can help you chart your daily life by spotting trends related to your mood, symptoms, life style and physical health.
• You can even send an e-postcard to somebody you care about!

Incorporating wellness into your life is just a click away!

The 2010 Legislative session was an extremely active and difficult session.  While the primary goal was to pass a bonding bill for long-term projects, spending on health and human services came into sharp debate.  Looking back at everything that happened, what will be the impact on mental health services?

We see four areas of major importance.  GAMC was the big concern early and late in the session, and we expect more news to come soon.  For more detailed history on what happened, you can read our previous entries here.  Right now, letters are going out informing people that GAMC is changing and that they must select a hospital home for clinic care.  Otherwise, they will be restricted to emergency only treatment.  What we don’t know is how the proposed patient limits will affect this process, or how many previously eligible individuals will complete their paperwork.  We suspect that this will be a major barrier.  What we do know is that this is bad news for people living in outstate Minnesota.  The four hospitals that agreed to this plan are all in the Metro area.  People can still go to the ER, but only for emergency treatment.  We are working to find other resources for people who need assistance with obtaining medication or other non-emergency care, but the outlook is not great.

Guardianship law was one of the few “wins” we had this session.  You can read our summary here.  This change introduces a basic level of accountability for guardians and protects the rights of individuals to make long-term choices about their health care.  We believe that it is an important piece of working towards models of care that better involve and respect the person’s wishes.  In addition, it showed that we can still make important policy changes, as long as they do not require funding.

MA expansion was brought up several times in the session, and has an uncertain future, even though it is strongly favored by providers.  We view it as the best long-term solution to the GAMC issue and it is required to happen in 2014.  At the end of session, the final compromise budget did not include early expansion of MA, but authorizes the Governor to trigger entry at a later time.  Gov. Pawlenty has staked out a public position against federal health care reform and is unlikely to do so.  However, the next Governor may not be opposed or simply not have any choice to refuse so much federal money.  You can read about the candidates’ stances on MA expansion here.

Funding for basic mental health services came into jeopardy this session.  When the state invested an additional $34 M in spending in the mental health system in 2007, it was seen as a major move forward.  Yet, we are now seeing major cuts that will quickly dwarf that investment.  It’s hard to interpret this as anything but a step backwards.  Some of these cuts are set to expire in 2011, but we know that it will take a lot of political will in order to resist sustaining those cuts as the budget crisis deepens.  State Operated Services will be redesigned and face cuts, despite delaying the inevitable by refusing to follow legislative and community input.  MHAM is pleased to be included with other advocates and stakeholders in helping outline what SOS truly needs to deliver.  While the cuts will be significant here, we are hopeful that an intelligent redesign process will limit the impact on consumers.

As these conversations continue through the election season and into the next session, we think that the State needs to face facts about budget cuts.  We believe that many of these shifts and cuts do not really last.  Property taxes are up sharply as counties try to recover from reduced aid from the state, and cuts to low-income health care typically raise the rates for those with insurance.  Supportive housing, PCA services, drop-in centers, and other long term/lower intensity services have all been on the chopping block.  But hospitalization, crisis response, and police involvement are far more expensive.  When these services are cut, the trade-offs have both human and financial costs, and we will work hard to push back against the band-aid approach to budgeting in the state.

Working towards the next legislative session, a few things are going to be different.

• There will be many new faces.  We will have a new Governor, but we will also have many new legislators as well.  Many retirements were announced as the end of session, and many elections will be hotly contested.  We see this as an opportunity to educate and inform new lawmakers about why mental health services are important and can reduce long-term costs.
• The deficit will be larger.  The funding “shifts” for K-12 education will come due, one-time funding has been used up, and tax revenues are still lower than in previous years.  The new Governor and the Legislature will have difficult decisions to make about how to balance the budget.
• Lastly, we hope that more of you will join us in calling, writing, and staying involved.  We know that contact from constituents made a big difference in outcomes this session.  We will continue our outreach across the state to LAC groups and other communities, and we would love to hear from you about getting involved.

May is Mental Health Month and we wanted to highlight some important initiatives regarding wellness and recovery. The Substance Abuse & Mental Health Services Administration (SAMHSA) earlier this year started the SAMHSA 10×10 Wellness Campaign. The campaign’s goal is to address all aspects of a person’s health and wellbeing in hopes of increasing life expectancy for people with serious mental illness by 10 years over the next 10 years.

The rates of diseases such as diabetes, cardiovascular disease, and respiratory disease and the early mortality rate from these types of diseases are often significantly higher for persons with serious mental illness. By addressing modifiable risk factors like smoking, obesity and inadequate medical care, can help reduce the progression or the risk of developing these diseases. The campaign provides a variety of resources, online issues of “Wellness Wisdom” and frequent teleconferences for providers, family members, and consumers.

To date, more than 2000 organizations and individuals have shown their support in promoting wellness to reduce morbidity and mortality for persons with SMI. The Minnesota Department of Human Services, along with other members of the community have developed a statewide initiative, Minnesota 10×10, which also promotes the importance of taking care of your physical health for living a healthier, longer life.

MHAM has joined this quest for wellness and we hope you will pledge your support for wellness too!

With the regular session fast approaching its end, the Legislature and the Governor have still not come to a budget agreement.  Gov. Pawlenty vetoed the Health and Human Services bill that we recently wrote about.  However, most observers see signs of potential compromise, that the veto letter indicated a willingness to compromise.  What we are concerned with is that the Governor is looking for other funding sources to pay for Minnesota’s share of MA expansion.

• The hospital and insurance surcharges are a fundamentally fair way of collecting this money.  Most of the organizations affected will also benefit greatly from expanded MA.  This is a fair trade in which everyone benefits.
• Previous funding sources included large cuts to the Adult Mental Health Grants.  We oppose these cuts strongly, as it is not wise to provide health insurance at the same time that we eliminate necessary mental health services.

We need a budget signed into law, and we know that this will involve compromise.  But we would strongly oppose a return to raiding mental health services to solve the budget crisis.

Once again, the future of mental health services are back in the hands of Gov. Tim Pawlenty. The House and Senate Conference Committee finally finished their negotiation of the final bill that would go to the Governor.  You can see the full details here.  These discussions have been long and tense, and many of the most important programs for our community were up for cuts.

The final bill is better than the Governor’s original proposal, and it is much better than the House proposal too.  But it still reflects the political and economic environment we’re in, and it will be a challenge to deal with in the coming year.  Please contact the Governor’s office and let him know what you think.  The compromise bill proposes:

• Restored funding for the Adult Mental Health grants supports community programs such as CSPs, drop in centers, and case management.  These grants were cut earlier in the session to pay for the GAMC compromise bill.
• Restored funding for ACT teams in rural areas.
• Cuts to housing with support for adults with serious mental illnesses.  However, these cuts are for 2010 and are not projected to continue at this point. All the major proposals have cut this amount.

We are particularly concerned for out-state Minnesotans at this time.  The Governor has taken it upon himself to modify the conditions of the GAMC deal struck with legislators earlier in the session.  When no hospitals would agree to participate, he  managed to convince 4 metro hospitals to accept a limited number GAMC patients.  There are two serious problems with this.  Patient limits were not part of the legislated solution, and may cut individuals off from needed care.  Secondly, four metro hospitals do not replace a state-wide safety net.  This is an unacceptable plan to people who do not live near the Twin Cities.

We would like to thank the members of the conference committee for hearing the needs of Minnesotans with mental illnesses.  We urge the Governor to do the same,

Since the MN Supreme Court decision reversing unallotment came down, we have known that budget negotiations would have to go into the final hours of the session.  But we are also facing new uncertainty about Federal funds that both sides were counting on to solve this biennium’s shortfall.

This means that the budget gap is now at about $3 B.  Obviously, this is a significant amount concentrated into the final year of the biennium.

The  plan proposed by the MN House and Senate majority addressed this new amount.  It would ratify certain parts of the unallotments, such as delays and shifts in K-12 Education funding and in local government aid.  What is significant about this plan is that it spreads the cuts more evenly that other proposals we have seen this yea. In addition, it plans on eventual restoration of the most important mental health related county grants and it raises new revenues through income taxes.  If the $400 M in Federal money does arrive, some money is put back into health and human services.

Passed narrowly last night, it met an almost instant veto from Governor Pawlenty.  There appears to be very little forward movement or compromise appearing.  Pawlenty has asked again for the Legislature to ratify his solution, but it was voted down by large margins in the House.

As we’ve said before, we hope that you will ask your legislators about what they have done to make a workable compromise possible.  There’s too much at stake to continue our present course of disappearing services and lost independence.

For over 60 years, Mental Health America – who began this tradition in 1949 – and other national and state mental health organizations have been celebrating “Mental Health Month.” In recognition of Mental Health Month, MHAM will be informing you about several important mental health initiatives involving both national and state led efforts. The central focus of these initiatives involves wellness and recovery for persons with mental illnesses. The importance of self-care and personal wellness not only can improve our mental health, but can also improve our overall health and well-being. So revisit our blog throughout this month and learn more about how these initiatives will help promote wellness and recovery for persons with mental illnesses.

Also, please check out our calendar of events that are occurring around the state for the month of May. If your organization is having an event and you would like it to appear on our calendar, please email details to Nancy at [email protected].

Yesterday morning, the Minnesota Supreme Court ruled that Gov. Tim Pawlenty’s unilateral unallotment of funds earlier in the biennium did not meet the statutory requirements for using that power.  The majority found that the language of the statute and the design of the State government do not allow for a Governor to use unallotment prior to agreeing to a budget.  Chief Justice Magnuson wrote for the majority (Link goes to PDF):

…we cannot conclude that the Legislature intended to authorize the executive branch to use the unallotment process to balance the budget for an entire biennium when balanced spending and revenue legislation has not been initially agreed upon by the Legislature and the Governor.  Instead, we conclude that the Legislature
intended the unallotment authority to serve the more narrow purpose of providing a mechanism by which the executive branch could address unanticipated deficits that occur after a balanced budget has previously been enacted.

The court chose to rule on narrow grounds, and it was a 4-3 decision.  They intentionally did not take up the question of the underlying constitutionality of the unallotment statute.  However, the implications represent a substantial shift in the balance of power at the Capitol.  Just hours earlier, Gov. Pawlenty had vowed to cut an additional $500 M from the budget if the Legislature failed to do so, invoking unallotment.  This decision makes that threat less credible.

Now, the pressing and serious question of how to balance the budget comes back to the Legislature. The full impact of this ruling is not yet known, but it is likely that it will create a substantial amount of conflict in the coming days.  The budget must be balanced, and Federal money that both Gov. Pawlenty and the Legislature was counting on has not yet arrived. They must agree to a  budget, but we do not expect the negotiations to be easy.  Deeper cuts and the potential for a government shutdown may be in the future, as Pawlenty as renewed his vow not to include revenue increases as part of the solution.

As the Health and Human Services budget is considered, this decision is going to play a significant role.  Many of the cuts made through the unallotment process were in this budget, and now must be renegotiated. We are already seeing strong signals that the Governor is unwilling to consider Medical Assistance expansion, even though hospitals have now refused to join in the replacement GAMC program.

Stay tuned and keep speaking up for mental health services in Minnesota.

As we continue to examine the House Health And Human Services budget, the worse the news gets.  We do not see an effective framework for managing costs or promoting the well-being of our community.  What we see are cuts to long-term programs that will lead to more crisis situations and worse outcomes for consumers.

Ways and Means will take up HF 2614 this Monday morning, and we need to make sure these Representatives get a lot more calls and emails in regard to these shocking cuts to mental health services before then.

Please call or email members of the Ways and Means Committee, or whoever is your Representative. Ask them to share with the Speaker that they do not support these devastating cuts to mental health services and will vote against this budget both in committee and on the floor if necessary.
Make sure you call your Representative regardless of their committee assignments, but in particular, members of the Ways and Means Committee need to hear about our concerns immediately.

Thank you to everyone who is helping make a difference in a very challenging time!