California Network of Mental Health Clients

Public Education & Policy :: Archive

CNMHC News Alert, April 2004

Mental Health Initiative will qualify for November 2 Ballot

Clients work hard to gather signatures

The Campaign for Mental Health announced at a March 19 Press Conference that the Mental Health Initiative has more than enough signatures to get on the November 2 ballot. The Initiative got 643,950 signatures, with over 100,000 coming from volunteer signature gatherers. Throughout California, mental health clients worked in coalition with other groups to gather signatures. Self-help programs also organized petition drives themselves, gathering 6500 signatures, with Project Return, the Next Step from Los Angeles taking the lead gathering 3500 signatures.

The Initiative will receive a number, after it formally qualifies to be on the ballot. This is expected in June or July.

In order to win in November, the campaign needs to reach millions of voters. This will take a paid media effort. The campaign has set a goal of raising $2 million dollars by October, 2004.

Get Involved

Visit the new website: www.campaignformentalhealth.org
Sign up for e-mail updates
Sign up to be an Online Volunteer
Share your story. The Web Site is featuring stories about why you are working for the Mental Health Services Act or your personal mental health/recovery story.

Save the Dates and Attend the following actions:

RALLY and WORK SESSION
At noon on Friday, May 7 in Contra Costa at Todos Santos Park in Concord. Join clients, family members, providers and advocates in rallying for the Mental Health Initiative, followed by a work group on the Initiative, and an after hours fundraising reception at the Concord Sheraton. For more information, call Mental Health Consumer Concerns: (925) 646-5788

MENTAL HEALTH ADVOCACY DAY 2004
May 27 is Advocacy Day 2004 in Sacramento. Join thousands of mental health advocates at the Sacramento State Capitol for the biggest Mental Health Advocacy Day of the past 10 years. For information call Dena Bloomgarden, the CA Coalition for Mental Health, at (562) 285-1330 #237 or e-mail: dbloomgarden@mhala.org.

ANNUAL DAY at the CAPITOL/RALLY and INFORMATION SHARING
On June 17, join clients for their Annual Day at the Capitol sponsored by the California Network of Mental Health Clients.

Support Voluntary Community Services and Peer Support Programs
Support Self Determination and Choice for Mental Health Clients
Fight budget cuts that attack the human rights and quality of life of people with mental disabilities
Advocate for the Campaign for Mental Health ballot initiative and other solutions which would bring services to the community.

For more information contact the CNMHC: 1-800-626-7447 or www.californiaclients.org

California Planning Medi-Cal Redesign

The Governor proposed structural reform of the Medi-Cal program in his January budget. As a result, administrators and policy makers are going through a massive Medi-Cal redesign process in the state. The California Health and Human Services Agency has begun a process to obtain stakeholder input regarding potential reform strategies.(More information about that process and meeting dates can be obtained on their website: www.medi-calredesign.org)

Redesigning Medi-Cal will redesign the kind of services we get and our ability to access them. The results could have a chilling effect on people with mental disabilities as well as all people with disabilities and people who use public health services.

DMH holds Stakeholder Meetings and Solicits Input

The Department of Mental Health will provide input to the Medi-Cal redesign process relating to the mental health system. DMH is holding stakeholder meetings to accomplish this. One stakeholder meeting was held on March 25. The next stakeholder meeting will be April 21, 1:30 - 4:30, at the auditorium of the Department of Social Services Building, 744 P Street, Sacramento. A pre meeting will be held for clients and family members from 10 AM to 12 noon at DMH's headquarters 1600 9th Street.

DMH has produced a "Discussion Paper" outlining preliminary ideas. Two specific ideas are of particular importance to the client community.

1. "Broadening sites where federal reimbursement for Medi-Cal services can be obtained, particularly 'freestanding psychiatric hospitals and psychiatric health facilities greater than 16 beds serving adults for inpatient services.'"

Under Medicaid law, no federal funds are available for inpatient care in "institutions for mental diseases" (IMD) for adults between the ages of 21 and 64. Medicaid will not pay for either a state-hospital stay or a stay in a specialized private psychiatric hospital for people in this age group of over 16 beds. Essentially this proposal lifts what is called the IMD exclusion. It frees Medi Cal dollars to reimburse hospital care of facilities over 16 beds.

The California Network of Mental Health Clients (CNMHC) is very concerned about this proposal. It would provide an incentive to hospitalize people. If beds are paid for by Medi-Cal, they will be filled. People will be diverted to hospitals, instead of community care; to forced treatment, instead of voluntary services. Services will follow the money.

Concerns:

Why support hospitals that are over 16 beds? Large hospitals have proven, by their very nature, to institutionalize.
Why not explore alternatives to hospitalization? Faced with the problem of not enough beds in some counties, why not explore other options to traditional hospitalization. Community crisis residential care, for example. When faced with a problem in resources for people in extreme emotional distress, why travel the old roads and answers, instead of creating alternatives in the community. It is a matter of changing the culture from thinking the same old institutional answers to thinking outside of the institution/hospital box.
Why support for- profit psychiatric hospitals, which fit the designation of free standing hospitals and psychiatric health facilities? They have been notorious in their placement of self-interest over patient interest.
Why provide the incentive to direct the flow of services away from the concept of Olmstead, community, self-directed care and recovery to the reopening of big hospitals and the institutionalization they represent.
The Department of Mental Health's proposed option is for acute, not long care, hospitalization. Would this stop with just acute hospitalization, or start the slippery slope toward the days of big institutional long term care? Also, how long is acute care?

Based on these concerns, the CNMHC has taken an opposed position to expanding Medi-Cal reimbursement for big psychiatric hospitals, acute or long term. Community services are less costly and more effective than hospitalization, as well as crucial to improving the quality of life for people with mental disabilities. Providing incentives to hospitalize people would ultimately lead away - if not lead funds away - from services in the community.

2. "Add recovery oriented consumer operated peer support services for adults at risk of repeat hospitalization."

There is growing pressure from clients and others for securing a federal or other secure funding stream for self-help and peer support programs.

The CNMHC has urged that maintaining and building self-help programs, which includes maintaining their integrity, should be a mental health policy priority. ("Self-Help and Peer Operated Services", CNMHC Position Paper on Self-Help)

Two States, Colorado and Georgia have developed special waivers to fund self-help programs/peer support through Medi-Cal.

However, there are many concerns about Medi-Cal funding for self-help services. For example:

That the source of funding does not medicalize self-help services, i.e., the need for diagnosis, charting, etc.
That peers retain control of the services, "client-run" is maintained, instead of controlled by a licensed clinician(s) to authorize services.
That the paper work/accountability necessary for documentation would overwhelm and undermine the services of self-help programs.
That the option not be restricted to a specific group who use self-help services, in the case of the CDMH proposal to those who are "at risk of repeat hospitalization."

The client community needs to discus this option thoroughly.

Medi-Cal reimbursement of peer support services is a way of ensuring sustainability of self-help and peer support services, especially in the current climate of funding mechanisms that discourage self-help programs and severe budget shortages. On the other hand, this funding stream entails a high potential to undermine/compromise the very essence of peer-run programs, what makes them successful and appealing to people who often won't use traditional services.

The CNMHC has recommended the following to the CDMH:

Convene a meeting of clients who are operating local self-help and peer support programs to have an in-depth discussion of Medi-Cal reimbursement of self-help programs, including exploring other avenues of bringing down federal dollars without having to bill services. The CDMH should listen to these experts/practitioners who are running self-help programs.
If the CDMH then plans to proceed with this option, the CDMH should use peer consultants on the design and language of the option. The people directly involved with the operations of self-help and peer support programs who know the most about the operations of their respective programs should have maximum involvement with designing any Medi-Cal billing option.

Let us know what you think about CDMH proposals for Medi-Cal redesign within the mental health system or contact CDMH directly at nmengebi@dmhhq.state.ca.us (Nancy Mengebier, Managed Care Unit) or 916-654-3486

Disability Rights Movement Fights Budget Cuts

On Thursday, May 20, the Disability Action Coalition will convene CAPITOL ACTION DAY to fight proposed budget cuts that threaten people with disabilities of all ages. A Rally will be held at 11 AM on the West Steps of the Capitol. Throughout the day folks will visit with legislators. For more information contact Teresa Favuzzi at 1-800-390-2699, e-mail: teresa@cfilc.org. The website for ongoing information is: www.cfilc.org