Financing Ohio's Behavioral Health System

Ohioans are dying from lack of access to vital services due to years of neglect in the state budget.

In a recent statewide poll, 2 out of every 3 Ohioans stated they were impacted by a friend or family member with an addiction and / or mental illness

• Based on the most recent statistics, suicides in Ohio are at a 10 year high. Most suicides (43%) occur in men between the ages of 36 and 65


• In Ohio, the annual deaths related to unintentional drug / medication overdoses are higher than the annual deaths due to vehicular accidents

How do we ensure access to life saving behavioral health services so that more Ohioans don't die needlessly?

1. Fund behavioral healthcare Medicaid Match from the state's 525 budget that was established specifically for Medicaid Match. It is no longer acceptable to shift costs to the local communities to pay for diseases of the brain while the costs for every other organ of the body are paid for from a well funded line in the state budget. This is stigma at its worst and must be corrected!

2. The local community levy for behavioral health services was never intended to offset the costs of a federal and state entitlement. These funds were intended to provide vital services to local residents not covered by these entitlements.

3. State funding for behavioral health care that was cut by @ $2 million locally must not be cut any further.

We have a choice now - Either provide our families and loved ones with the treatment they need so that they can live full and productive lives at a fraction of the cost of providing care in emergency rooms, jails, prisons, and long term care facilities at a massive cost.

Please tell our local legislators Senator Keith Faber, Representatives Matt Huffman, Cliff Hite, and John Adams that our families and our communities are depending on them to make the right choice.

Mike Schoenhofer

Ohio's Community Mental Health System at a Crossroads

According to the Cleveland based Center for Community Solutions, a think tank dedicated to providing strategic leadership in the areas of health, social, and economic conditions, Ohio's mental health system is collapsing due to a lack of investment over many years. This lack of investment is leading to high costs in other systems and poor health outcomes.



Funding Cuts Cost More

According to Susan Ackerman, Fellow, Public Policy and Advocacy at the Center, Ohio's community mental health system is on the brink of failure and collapse. A combination of factors over time has led to this situation. But, among these factors, the lack of funding is the most damaging. Failure to meet the needs of people with mental illness in a community setting has resulted in increased hospitalizations, nursing home placements, and incarceration. Not only are these alternatives inappropriate - and in many cases inhumane - but they are significantly more expensive.


Though Ohio faces a crushing state revenue shortfall, more spending is needed now to stabilize the communty mental health system. This would not only improve the care of individuals with mental illness but would be prudent fiscal policy as it would stave off the need for future spending in other systems that are ill-equipped to provide long-term treatment and stabilization for people with mental illness.

ADAMHS Boards Worked!

The funding structure that initially created Ohio's Alcohol, Drug Addiction, and Mental Health Services Boards was initially very effective at deinstitutionalizastion, reducing the number of state hospitals from 17 to 7 representing better care in community settings and massive institutional cost savings. However, now that those savings have been realized it is important that funding levels be tied to cost drivers in the community mental health system - caseload, price, and service utilization.

Have we returned to the 1840's?

Around the country, care for people with severe mental illness is reverting to something that resembles the system that existed when Dorothea Dix began her raids on jails and almshouses in the 1840's. Ohio has the chance to reverse it current course, by leveraging the changes that resutl from federal health reform and actively design a system that will improve the health of our citizens. Nowhere else is it more important to seize this opportunity right now than in the behavioral health system.

Mike Schoenhofer

Behavioral Health Care IS Health Care

There is an increasing need for community based alcohol, drug addiction, and mental health services. Unfortunately, this increasing need had been met with decreasing financial support from the state. We hope it is the result of lack of understanding on the part of lawmakers that behavioral health care is a vital part of an individual's overall health.

Perhaps there is a confusion that mental illness or addiction are really just people "acting badly or misbehaving" rather than truly understanding that these are diseases of the brain, biologically based, and just as lethal as any other untreated illness like cancer or heart diesase.

In the previous state budget, the Governor explained that "health care was held harmless from budget cuts," when in fact behavioral healthcare locally was cut by $1.7 million. Perhaps the Governor didn't understand that mental illness and addiction are killers too.

Perhaps there is a greater tolerance at the Governor's Mansion and in the State House that persons with brain disorders can find treatment in jails, nursing homes, and emergency rooms? That sounds like prejudice to me.

Please stand with us in helping our lawmakers understand the critical need for mental health and substance abuse services in our local communities.

Behavioral Health Care is Health Care.

Mike Schoenhofer

Girls More Vulnerable to Substance Abuse?

Parents of teenage girls may be surprised to learn that their daughters may be more vulnerable to developing alcohol and drug problems than their male counterparts according to a survey by the Partnership for a Drug Free America. They are more susceptible to substance abuse because they are more likely to use alcohol and drugs to self-medicate.

Specifically, teen girls more than boys perceived the potential benefits of using drugs and alcohol.

The fact that girls, more than teenage boys think that drugs can help them deal with their problems was revealed in an analysis of the 2009 Partnership Attitude Tracking Study.

Girls More Likely to Turn to Drugs

Some of the findings of the study about teen girls included:

• 68% of girls said "using drugs helps kids deal with problems a home"


• 53% said drugs helped teens forget their problems"


• 59% of teen girls reported using alcohol


• Past year use of marijuana increased 29% from 2008 to 2009

Boys Drug Use Increasing

The report also foudn some disturbing trends among teenage boys:

• The percentage of boys who said "drugs help you relax socially" grew from 45% in 2008 to 52% in 2009


• 34% of boys said "parties are more fun with drugs"


• Use of marijuana increased among boys 15% between 2008 and 2009

Parents should pay close attention to their daughters' moods and mental health neds while addressing their worries and stresses. If parents suspect their teens are experimenting with drugs, they should take immediate action.

If you are concerned about your son or daughter using alcohol or drugs please call either the HopeLine 1 -800-567-4673 or Family Resource Centers 419-222-1168

Mike Schoenhofer

Addiction is a Disease of the Brain

A few times a week someone calls and asks for help because of an addiction they are struggling to overcome or an addiciton of a loved one. Addiction is a complex brain disease. It is a chronic disease characterized b y craving, seeking, and use that can persist even in the face of extremely negative consequences. Accohol and other drug seeking behavior may become compulsive, in large part, as a result of the effects of prolonged use on brain function and on behavior.

Addiction is considered a brain disease because alcohol and other drugs change the brain - they change its structure and how it works. These brain changes canbe long lasting, and can lead to harmful behaviors seen in people who abuse alcohol and other drugs.

According to Dr. Daniel Amen, alcohol and other drugs have a significant and seriously debilitating impact on the brain. In brain image scans the brain of an addict looks like it is full of holes.







Why does this matter?

1. Unintentional drug poisioning is the leading cause of injury death in Ohio, surpassing motor vehicle crashes and suicides for the first time on record.

2. The death rate in Ohio due to unintentional drug posionings increased 350% from 327 in 1999 to 1,472 in 2008.

Now more than ever we need strong community based alcohol and drug treatment and prevention programs that are designed to keep kids from getting started on drugs and to get people into recovery who have developed an addiction.

Funding cuts to behavioral health services for some is a death sentence and for others means a lifetime of suffering and imprisonment.

Addiction is a treatable disease. Success rates for addiction treatment exceed success rates for other chronic illnesses - approximately 70% of men and women who complete treatment and attend self help groups like AA, NA, or Celebrate Recovery are likely to remain abstinent from alcohol or other drugs.

Please join with us in advocating for treatment and prevention programming. Our families and loved ones need our help!

Mike Schoenhofer

We All Need a Little Help from Our Friends

A few years ago just after my father died unexpectedly, my mother was looking for a grief support group. The first one she tried was very clinically organized and she ended up crying most of the time the group was in session and for hours after it was over.

Then she discovered a simple peer group of women who had lost their husbands. They spent some time talking but then the rest of the time they played cards and then went out to lunch. My mother never missed another group after that.

As one clinician told me, "Sometimes we just over therapize people." Sometimes we just need a little support. For persons with serious mental illness the greatest threat they face is social isolation and so support groups become a life line. But we all need those social supports and without them slowly become isolated and depressed.

Celebrate Recovery is a wonderful example of a faith-based support group for people with all manner of habits, hurts, and hang-ups. The groups meet at St. John's Church on Wednesday at 6:00 PM and at the Church at Allentown at 8:00 PM on Saturday. Whether your hang-up is substance abuse or your hurt is depression there are people there who share your pain and can lift you up.

Just like my mother, sometimes we all just need a little help from our friends. I hope you find the support you need.

Mike Schoenhofer

More Mentally Ill Persons Are in Jails and Prisons

Using using 2004 - 2005 data not previously published, the natiounal sheriff's association found that in the United States there are now more than three times more seriously mentally ill persons in jails and prisons than in hospitals. America'a jails and prisons have become our new mental hospitals.

Recent studies suggest that at lest 16 % of inmates in jails and prisons have a serious mental illness. In 1983 as similar study reported that the percentage was 6.4%. Thus, in less than three decades, the percentage of seriously mentally ill prisoners has almost tripled.

It is now extremely difficult to find a bed for a seriously mentally ill person who needs to be hospitalized.

In historical perspective, we are returning to the early nineteenth century, when mentally ill persons filled our jails and prisons. At that time, a reform movement sparked by Dorothea Dix, lead to a more humane treatment of mentally ill persons. We have now returned to the conditions of the 1840's by putting large numbers of mentally ill persons back into jails and prisons.

Dr. Stephen Moffic, a prison psychiatrist at a Wisconsin Prison, says that in many cases prisoners have better access to mental healthcare in prison than in the community because the community's resources have been so drastically cut.

What a shame that people may have to be imprisoned in order to have good access to mental health care and at what cost to our economy and at what human cost! The state can solve this problem if it has the political will.

Mike Schoenhofer

OF-1-MIND: www.of-1-mind.org

Why is behavioral healthcare treated so much differently than physical healthcare? Is it stigma? Is it lack of knowledge? Yet 1 in every 4 Ohioans has a diagnosable mental illness and 1 out of 10 have a substance abuse problem or addiction.

These are your family members, friends, neighbors, co-workers, and classmates.

It is time to speak out on behalf of ourselves and those we love. Mental illness and addiction are diseases of the brain that not only impact the health of an individual but also the health of our families and our communities. That is the reason why the Ohio Association of Behavioral Health Authorities launched the education and advocacy campaign: OF-1-MIND.

Think of this, recovery rates for major mental disorders are far greater than for other physical illnesses like heart disease. For every dollar spent on treatment, there is an economic return of at least $7 when taking into account productivity at work and school, reduction in crime, child abuse, and homelessness. And most importantly, recovering people work.

Please log onto http://www.of-1-mind.org/ to get involved in this vital campaign.

Now more than ever you owe it to yourself, your family, and your community to make a difference and to let your voice be heard. Maybe one day we can accomplish the vision of the President's New Freedom Commission on Mental Health; that is, ". . .a future when mental illnesses can be prevented or cured, a future when mental illnesses are detected early, and a future when everyone with a mental illness at any stage of life has access to effective treatment and supports. . ."

Mike Schoenhofer

Three Out of Five Ohions Affected by Mental Illness and/or an Addiction

In a recent survey of 414 households in December 2009 conducted by the Ohio Association of Behavioral Health Authorities, 45% of the respondents reported they had a friend or family member who has a substance abuse problem. Almost one out of two respondents were aware of a friend or family member with mental illness (49%). When combined, 63% of respondents had someone they were close to suffering with a behavioral health issue - that's three out of five.

Amazingly, almost 60% of respondents agreed that drug and alcohol addiction is a diesase of the brain and 96% agreed that through treatment these men and women can become productive citizens.

When it comes to mental illness 83% agreed that it is a diesase of the brain and also agreed that people with mental illness can recover.

It is estimated that one in four Ohioans have a diagnosable mental disorder in any given year.

• 63% of Ohioans have a family member or friend with a mental illness and /or substance abuse disorder


• 25% of Ohioans have a diagnosable mental disorder

We need to pay be paying attention to this epidemic.

These disorders are treatable! Look at the success rates of behavioral health conditions compared to other physical disorders:

• Bipolar Disorder 80% success rate


• Heart Disease 45% success rate


• Schizophrenia 60% success rate


• Hepatitis C 40% success rate


• Addiction 60% success rate

This is a time when we have the technology and the means to successfully treat our loved ones so that they can become productive citizens. With so many of our citizens impacted by mental illness and/or substance abuse shouldn't we be paying attention to this issue.

It is time we make our voices heard. Our silence does not help the ones we love who need us all to speak out on their behalf.

Let's afford the right to the "pursuit of happiness" to all of our citizens by making sure that the treatment they deserve is there when they need it.

A small investment in treatment today create a productive citizen tomorrow.

Mike Schoenhofer

Faber, Huffman, Hite and Adams can do the right thing

I have just come from a Board meeting where services for adults, children, and families with mental illness and substance abuse will be reduced by almost $400,000 beginning in July. This is a tragedy for our families and a tragedy for our community. Yet there are three things our legislators and Governor could do that would not cost the state anything and yet have a huge impact locally. Here they are:

1. Medicaid Administrative Claiming - Local Boards could receive federal funding for the work they do in overseeing the Medicaid Program. Locally, that could mean up to $50,000 a year. I ask, "Why aren't our legislators and Governor advocating for us?"


2. Medicaid Program Oversight - Currently the Medicaid program is completely unregulated and the costs of services are so out of control that they threaten to wipe out prevention programming, programming for school children, crisis services, and supportive services for adults. By simply passing legislation that gives local Boards the authority to oversee amount, scope and duration, hundreds of thousands of dollars could be saved just in Allen, Auglaize and Hardin Counties alone. I ask, "Why aren't our legislators and Governor working to help us reign in a runaway program?"


3. Medicaid Benefit Package - Currently recipients of Medicaid Healthcare programs have better coverage than every working family in the state. Shouldn't our state government be seeking an equal coverage for our citizens regardless of socioeconomic status. A clear benefit package with reasonable limits on coverage based on diagnosis needs to be implemented immediately saving taxpayers hundreds of thousands of dollars annually. I ask, "Why aren't our legislators and Governor paying attention?"

Many of our local citizens are being denied access to lifegiving services because our state legislature has not taken responsible action.

Please email your legislator today.

Senator Faber: SD12@senate.state.oh.us

Representative Hite (Hardin): district78@ohr.state.oh.us

Representative Adams (Auglaize): district78@ohr.state.oh.us

Representative Huffman (Allen): district04@ohr.state.oh.us

The Power of Partnership

The idea of "rugged individualism" has been part of our collective myth for centuries. The images of the pioneer, cowboy, or even the Lone Ranger struggling against insurmountable odds are enthralling. Yet this individualist approach pales in significance to the power created in partnerships. Whether it was the struggle for independence in our American Revolution or the search for the cure of disease, it was the collaborative effort of people coming together for a single purpose that created success.



For the past 10 years the We Care People have worked to create partnerships within our communities so that people could recieve the care they needed in order to live the life they deserved.



Partnerships like the ones we have with Law Enforcement, Courts, DD Boards, Health Departments, Schools, Faith Community, CSB, Aging, and Housing have created many portals for anyone in need to find and receive help. What we have all created is stunning! It is a system of care that is always under constrtuction; a work in progress. And it must be a work in progress because as we learn and change and improve so too our systems must learn, and change and improve.



More partners means more opportunities to grow and we welcome that with open arms. It is a work that will never be finished.



This week we are inviting more agencies to come together with us to not only learn what we do but we hope to contribute to our learning of what needs to be done.



"No man is an island," observed John Donne, "No man is an island, entire of itself . . . because I am involved in mankind." What is true for each of us, our need for connection with others, is true for agencies, organizations and systems. In our partnerships there is power that enables us to discover new approaches that create better lives and a better community.



Thank you to all who have walked with us, learned with us, and created with us this wonderful and ever growing system of care over the past decade.



Mike Schoenhofer

Relearning Cultural Competence in our System

Monday marks the 81st birthday of Dr. Martin Luther King, Jr. This is a time for us to reflect on those things which we have accomplished in our journey to a more socially just community, and to identify those areas which are our growth edges.

Traditionally, mental health and substance abuse systems and professionals have been a proactive group about issues of inclusion, equality, access, and dignity. A simple scan of our system shows so many people and organizations working to balance justice for our consumers. Every day, people who are marginalized by larger majorities are included in our services, shown compassion by our providers, and restored to their rightful places through the recovery supports they receive.

All of the agencies and providers in the We Care system have strong policies and leadership about respecting the differences of clients - their cultures, races, unique experiences, points of view, and histories. I have personally seen directors of our agencies take strong stands against discriminatory practices and interactions, advocating on behalf of our consumers with conviction that makes me proud to be their colleague. Every day our providers set aside the confines of their own culture and experience to nourish their understanding of our consumers' culture and to create a niche of safety for them to express themselves and to grow.

We have a unique asset in Lima UMADAOP. One of only 12 such organizations in Ohio, the Lima UMADAOP exists to ensure that African American and Hispanic/Latino people in our area receive prevention programming that is culturally appropriate. Lutheran Social Services, whose parent organization has a long history of attention to social justice, has one of the only Spanish-speaking counselors in our region, and has opened a thriving set of group services for people who are lesbian, gay, bisexual, and transgendered. Family Resource Centers, our agency that concentrates on children and families, works every day in community settings such as schools to empower consumers who represent all types of familes, not just the traditional family with two parents and a white picket fence. It's all tough work, and in some ways very countercultural.

Even with these great examples, we need to do more. Cultural competence is often a sideline or even an afterthought in our program design and evaluation. Though we are well intentioned, we often neglect to ask the question of our consumers: "what do you really need from us, and do we create it with you in a way that celebrates the unique person you are?"

Dr. Debra Wilcox is a friend and mentor in this issue of deliberate attention to culture. She works with the Wellness Management and Recovery Coordinating Center of Excellence and is president of Confluency Consulting, Inc. She shares these ideas for enhancing our expertise and shaping our attitudes. She sees that providers need certain beliefs, attitudes, knowledge, and skills to improve their practice.

Beliefs and Attitudes
Culturally skilled counselors have moved from being culturally unaware to being aware and sensitive to their own cultural heritage and to valuing and respecting differences.
Culturally skilled counselors are aware of how their own cultural background and experiences, attitudes, and values and biases influence psychological processes.
Culturally skilled counselors are able to recognize the limits of their competencies and expertise.
Culturally skilled counselors are comfortable with differences that exist between themselves and clients in terms of race, ethnicity, culture, sexual orientation, gender expression, and beliefs.

Knowledge
Culturally skilled counselors have specific knowledge about their own racial and cultural heritage and how it personally and professionally affects their definitions and biases of normality-abnormality and the process of counseling.
Culturally skilled counselors possess knowledge and understanding about how oppression, racism, discrimination, and stereotyping affect them personally and in their work. This allows them to acknowledge their own racist and sexist attitudes, beliefs, and feelings. Although this standard applies to all groups, for white counselors it may mean that they understand how they may have directly or indirectly benefited from individual, institutional, and cultural racism (white identity development models).
Culturally skilled counselors possess knowledge about their social impact upon others. They are knowledgeable about communication style differences, how their style may clash or facilitate the counseling process with minority clients, and how to anticipate the impact it may have on others.
Skills
Culturally skilled counselors seek out educational, consultative, and training experiences to enrich their understanding and effectiveness in working with culturally different populations. Being able to recognize the limits of their competencies, they (a) seek consultation, (b) seek further training or education, (c) refer out to more qualified individuals or resources, or (d) engage in a combination of these.
Culturally skilled counselors are constantly seeking to understand themselves as racial and cultural beings and are actively seeking a non-racist identity. (Wilcox, 2007).

Throughout 2010, it is our commitment to remember to ask the questions of our consumers, our providers, and our system that lead us to a deeper understanding of the true cultural needs and aspirations of our consumers and our workforce. Every time we raise the question, we learn and we move our system and ourselves toward a deeper justice for all.

Peace,
Phil Atkins