In more ways that one, the recent budget settlement is about going back to work.  The state government ordered employees to report as normal this morning, and will be bringing back functions and services as able.  For the politicians, they now go to the task of explaining, spinning, selling their actions to their constituents.  For us?  It means trying to fully understand where the impacts of this budget will be felt, and setting the stage for next year.

Because Minnesota borrowed money to patch the budget, it is very unlikely that we have hit bottom in terms of service cuts and reductions.  State grants to counties have been cut, something that we tried very hard to avert.  Much like in the years leading up to the successful reforms of 2007, we find ourselves with a mental health system with less and less capacity to foster recovery and support people in the community.  What will it take to get another victory, and start investing in mental health again?

But there are bright spots, as well as concerns.  Counties will still have spending requirements for mental health services (known as maintenance of effort).  This has been a major point of contention, and we are very relieved to see this.  The efforts to repeal the expansion of Medical Assistance were turned back.  And some of the crisis grants that help get people to treatment instead of taxing the 911 system were preserved.

This is a very mixed verdict, and one that will be difficult for many of us.  MHAM is more determined than ever to make the case at the capitol for community mental health.  We are so grateful for everyone who called, wrote, and pushed their legislators to consider the impacts.  We hope you will stick with us over the break (we will update as needed, but less often than in session) as we get ready for another chance to make things better.

For more details, please read our update on the website.

Are you feeling the impact of the state government shutdown yet?  If you care about accessible mental health service, the chances are you have.  Not not everyone is equally affected.

As the shutdown drags on, however, the number of people impacted is going to expand greatly. Construction projects are stalled, some restaurants can’t restock because their liquor license has expired.  Racetracks and state parks are closed.  Resorts are losing business, because fishing permits are on hold.  Lottery tickets can’t be purchased in MN.

While the ability to enjoy many of these recreational opportunities will not be “critical” as defined by Judge Gearin’s rulings, they are the kinds of things lots of folks notice.  We hope that people will take their frustration about these things and join the chorus: find a budget compromise, as free as possible from divisive policy issues, and get the state back to work.

We all play a role in creating the voice of the people.  Not everyone uses every service the state provides.  You might notice a different impact of the shutdown than what others do.  So speak out, and make sure your priorities are heard.  We need to make sure that we are reminding our elected officials that we expect the state to continue to fund programs and services that help make recovery a possibility for all Minnesotans with mental illnesses.

For more detail, please see our weekly update.

Although the health care bill has recently passed, many of the new provisions will not take effect for some time.  For recent college graduates, staying on their parents’ coverage may be a good option since many insurance companies have already expanded their coverage to the children of dependents until they are 26.  As of last fall, health plans must offer this.  However, this might not be an option for everyone.

One important thing during this time of transition is to be consistent with a medication plan. In order to do so, it is a good idea to talk to your doctors before your coverage changes in order to develop strategies so that you guarantee continued coverage of your medication.  This will insure that you stay healthy both physically and mentally.  Getting a prescription for a 90 day supply is one potential option.

If you plan to buy your own health insurance, learning about the different options and plans is crucial.  First, it is a good idea to figure out how long you may be under or uninsured.  This would help you to decide if you should look at short-term health insurance plans or more long term plans.  Healthcare.gov has information on eligibility for public and private health insurance plans.  EHealthInsurance.com is a for-profit website, but can offer a useful comparison of different private plans.

Many insurance companies that provide short term insurance, offer plans where you can buy insurance a month at a time, usually for up to 6-12 months.  However, it is important to understand that short-term plans only provide coverage in the event of an emergency or a catastrophic event.  Many short-term plans don’t cover regular check-ups, pre-existing conditions, prescription medications, or other preventative care needs.

When considering a health insurance plan, learning about the limits and constraints of high deductibles vs. low deductibles, as well as the premiums is vital.  When considering an insurance plan, the annual deductible is the amount of money you have to pay out of pocket before your health insurance kicks in.  Normally, the higher the deductive, the lower the premium, or monthly payment.

Along with the security of health insurance, there are also several clinics that offer sliding fees. Depending on your income and other expenses, certain clinics can adjust the price of their services and other health care needs.  You can find more resources on our website or by calling one of our individual advocates.

Though graduation is accompanied by celebration and excitement, there are also lots of things to start thinking about.  It is especially important for people with mental illnesses to plan ahead when thinking about health insurance.  This summer in particular may leave many people not only jobless but also without the medical coverage they need.

Speaking with health care professionals and advocates can help.  They possess the tools and resources that can help in alleviating possible long-term stress or more serious illnesses.  Taking the time to learn about your options and coming up with a strategy now will certainly help you avoid the pain and anxiety of being in need of medical care later, and not having the coverage to afford it.

This post comes from volunteer blogger Margo Tell.

This week’s update really puts a focus on how cuts in the last few years have effectively rolled back the bipartisan 2007 reforms.  $34 million of new grant money was going to really change the way that mental health services are delivered in the state, by putting more focus on the community providers and what we can do to keep people from needing in-patient care.

The good news is that it worked.  Hospital bed days were down, crisis services were started, and people got the help they needed, where they were. (Link goes to PDF)

The bad news is that last year’s cuts totaled 15 million.  The proposed HHS budget that Gov. Dayton vetoed for being too drastic would have cut even more than that.  In 2007, members from both parties and Governor Pawlenty proudly said that $34 million would change the system.

So what would these cuts do?

Care Manager vs. Primary Care Provider…does it matter who you are seeing in regards to your health?  In some cases it may.  NIMH supported research has shown benefits for people with multiple medical conditions who use primary care plus case-managed care.

According to CMSA, the term “case management” is defined as “collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes.”

To evaluate the effectiveness of this combined approach, Wayne Katon, M.D., of the University of Washington, and other colleagues conducted a study that zeroed in on methods of care for patients with diabetes or heart disease and depression.  Patients such as these, on average, tend to practice poorer self-care methods and experience more complications due to treatment.

To aid in decreasing these detrimental issues researchers developed a model in which a nurse care manager and primary care provider coordinated care.  This approach was used to ease depression symptoms and improve medical conditions.  Of the 214 patients that participated in this study, half experienced a 12-month trial with the additional case management. In this trial the nurse care manager’s role was to act as an advocate for the patients by informing them about their medical condition and by motivating them to take a more proactive role in their treatment.  The remaining half of the patients were treated with usual care, solely by a primary care provider.

The two groups were compared and the result of this study showed that patients experiencing the case management found it to be a successful approach.  More  of these patients reported a decrease in depressive symptoms, improved blood glucose levels, and improved blood pressure when compared to patients that only received the primary care.   The recipients of the additional resources also reported better overall wellness and felt their care had improved.

Currently in action, The Diamond Program and MN 10 by 10 have been implemented in Minnesota to promote  holistic approaches to mental illness.  The Diamond program includes primary care physicians, consulting psychiatrists, care managers, and other mental health specialists working together to provide the best care for patients.  The care manager plays an important role in this process in that they manage the components of the program for the patient.  The patient is responsible for taking an active part in their own care. MN 10 by 10 aims to reduce early mortality of the persons with mental illnesses by 10 years in 10 years. Similarly, this program focuses on improving primary care by educating health care professionals (social workers , case managers, primary care physicians, counselors etc…).  They also provide information such as health check lists are available to patients so they can learn how to get the most for their doctor visits.

At the end of the day it is important for these programs to continue educating health care professionals on how to built the best possible care for individuals faced with multiple medical conditions.  This will hopefully generate more satisfied patients who then become motivated to take better care of themselves.

At MHAM we offer Steps to Wellness that can be use as a helpful guide in learning how to motivate yourself in terms of improving your own wellness. To order the Steps to Wellness kits, please call us at 651-493-6634 or kits can also be ordered online. Individual items from these kits can be downloaded from our website as well. Providers that need multiple copies, please contact Brett Dumke, Education Coordinator, at [email protected].

This post was written by Jahna Sandkamp, who is interning with MHAM this Spring.

By Ben Ashley-Wurtmann, MHAM Policy and Outreach Associate

In the wake of the tragic shooting in Arizona, many people have been asking questions about the mental health system and how it responds to individuals who may be capable of violence.  We believe that a strong health system is better able to handle individuals in crisis when it focuses on providing a strong continuum of care.  When every case is an emergency, few people will get the kind of care they require.  However, some of the discussion around the nation has been focused on the perceived danger presented by “the mentally ill.”

The truth is that people with mental illnesses vary greatly in terms of the symptoms they experience, the personalities they have, the experiences they have lived through, and the extent to which their illnesses affect their daily life.  Simply put, there is no one experience of mental illness, or even a particular condition, such as schizophrenia.

An interesting article was posted by the Wall Street Journal, questioning the validity of link of violence and mental illness caught our attention.

But another, more recent study showed that people with schizophrenia are no more likely to commit violence than those without mental illness. That research did find an increased risk of violence among those with schizophrenia who are also using drugs or alcohol.

Complicating things is that even if someone with schizophrenia commits a violent act, the illness isn’t necessary[sic] the reason for the behavior, say experts. With regard to Loughner, “my concern is that people immediately leap to the explanation that [the mental illness is] the master answer to why he committed this crime,” says Swanson. “It’s much more complicated than that.”

These are both important points to keep in mind.  Mental illnesses do not automatically make people violent, nor do they explain everything there is to know about a person.  More than ever, the public understands that mental illnesses are biological and treatable.  Unfortunately, this has not led to a reduction in stigma. This is an ongoing conversation at MHAM as we pursue our vision of improved lives for people with mental illnesses.  You can find more about how stigma works and how we are changing our struggle against it in our recent newsletter (page 4), on our blog, in the news, or by contacting us at [email protected].

Just a reminder that in recognition of Mental Illness Awareness Week, MHAM is hosting the Celebrating Recovery education event on Tuesday, October 5 at the Ramada Plaza in Minneapolis. The event will begin at 9:30 a.m. and conclude at 3 p.m. We would love to see you there! If you register before October 5, admission is $15. At the door admission is $20. Your admission includes presentations, a Wellness Fair, a Steps To Wellness self-care kit, and lunch.

This will be a great event for individuals living with mental illnesses, their family members and friends, and mental health providers. Michael Trangle, MD will speak about holistic care and staying healthy and Minnesota 10 x 10 and the DIAMOND program. Kim Lutes will share her experiences with the mental health system and the importance of self-advocacy. Brain Doran will discuss ways in which family members and friends can support a loved one who is living with a mental illness. Brett Dumke will provide an overview of the brand new Steps to Wellness self-care kits. Ed Eide will give examples of how individuals can share their stories to influence public policy.

The Steps to Wellness kits have been developed with support from an educational grant from Lilly USA, LLC, a charitable contribution from Janssen, Division of Ortho-McNeil-Janssen Pharmaceutical, Inc., a grant from Park Nicollet Foundation Healthy Community, and a grant from Pfizer Healthcare. The kits contain tools to help individuals manage their health and learn skills to advocate for themselves when working with medical professionals and social service providers. After the event, the kits will be available for order from the MHAM website.

Tickets to this event are still available. Please see the Celebrating Recovery page on our website to register online. Scholarships are available. To arrange for a scholarship, please contact Ed Eide at 612-843-4868, ext. 1 or edeide at mentalhealthmn.org.

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.

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].

With spring’s arrival the gardeners come out of hibernation, the birds return, the leaves unfold…and the college acceptance letters arrive.  As students across Minnesota discover where they’ll be going this fall, it is a great time to begin planning for the transition to college.

The first year of college can be challenging.  Not only do new students have intense academic pressure to cope with, but they are adjusting to a new location, new people, and separation from family.  Adapting to these changes is difficult for most people, but for a person with a mental illness, it can be even more complicated.  On top of everything else, they have to arrange for academic accommodations, continued treatment, and sufficient emotional support.  For students facing college with the added challenge of a mental illness, planning ahead can save a lot of stress down the road.

Many students with mental illnesses aren’t aware they have the right under the Americans with Disabilities Act (ADA) to request accommodations from public and non-religiously affiliated private colleges and universities.  An accommodation is an adjustment in how things are done that allows a student with a disability equal access to academic programs.  Each college may have it’s own standard for what is considered reasonable.  Generally, an accommodation can’t change the nature of the program or give select students an unfair advantage.

To find out if an accommodation would be useful to you, take a moment to think about your experience as a student so far.  What have you struggled with? What types of support helped? Did the support come from outside resources (family, friends, therapist) or from within the school (teachers, students, tutors)?  What helped you be successful?

There are many types of accommodations commonly requested by students.  Some find it helpful to record lectures, others request extra time for exams or a modified course schedule.  Some accommodations are personal, and can be made independent of the college (taking evening courses, adjusting your medication regime, getting a private tutor).

Before you request an accommodation, take a moment to consider your need for privacy.  What information are you comfortable sharing with professors, administrators, or your fellow students? Be aware your college may require you provide medical documentation before they provide an accommodation.  The disability support services office at your college should be able to assist you in making an accommodations request.

In some cases, you may need to leave college for an extended period of time for your mental health.  Take time to review the medical leave policy at your college.  If you take medical leave, they should allow you to return to college without a penalty or disciplinary actions.

It’s important to take a look at your insurance coverage before you attend college.  Will you be covered by your parent’s plan? Will your plan cover out-of-state providers?  Can you get prescriptions filled at the pharmacies in your new town?  If you will not be covered by health insurance, does your college offer free or low-cost mental health services to students?  If not, will you qualify for any state health insurance plans?

Whether you are covered or not, emotional support can be extremely valuable during transitions.  Before you go, check in with your friends.  What’s the best way to stay in touch?  Even one email a week can make a difference.

A little advanced planning can make a big life change a lot less stressful.  If you need help planning your transition, contact an advocate from MHAM at 612-331-6840.  Advocates are available Monday-Friday, 9-4:30.

You can find more information about accommodations and attending college with a disability at: Minnesota State Colleges and Universities, Parent Advocacy Coalition for Educational Rights (PACER) , and the Association of Higher Education and Disability (AHEAD).