A Compendium of Current Federal Initiatives in Response to the Olmstead Decision. OLMSTEAD RELATED ACTIVITIES AT THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

07/10/2001

Funding Organization:

  • Substance Abuse and Mental Health Services Administration (SAMHSA)

Implementing Organization:

  • Substance Abuse and Mental Health Services Administration (SAMHSA)

Purpose:

As the lead agency in the Department of Health and Human Services on matters related to mental health and substance abuse, SAMHSA established an internal working group and is currently addressing policy, technical assistance and training activities to implement the Supreme Court's directives in the Olmstead decision.

Description:

SAMHSA's response to the Olmstead decision is being directed for the Agency by the Center for Mental Health Services (CMHS). The array of actions related to the Olmstead Decision includes:

Agency-Wide Olmstead Meetings. Chaired by Bernard Arons, M.D., Director of CMHS and Olmstead Program Director, these meetings are held monthly or as needed to discuss Olmstead related mental health and substance abuse disorder issues as they affect SAMHSA's planning, policy and funding priorities.

National and State Coalitions to Promote Community-Based Care for Persons with Mental Illness. This initiative addresses barriers and recommendations at the national and state levels in support of integrated services for persons with mental illness. The primary objective is to assist states in developing and enhancing state coalitions addressing the Olmstead decision. The National Coalition's role is to help establish guidelines and recommendations, identify models, best practices and technical assistance resources, and help disseminate information on Olmstead implementation and effective community integration plans.

The National Coalition was implemented in December 2000 with a Kick-Off Meeting representing more than 60 members including a wide cross-section of federal agencies, national advocacy groups, consumer organizations, and professional associations.

State Olmstead Coalitions. A Financial Assistance Application ($20,000 per jurisdiction) to support state coalitions was sent out in March 2001. As of June 2001, 43 states are funded, one application is pending, one is in uncertain status, four are expected to submit applications and four declined to apply. Of the funded states, 88 percent support existing coalitions and 12 percent are starting new coalitions. All states identified a staff person to serve as the Olmstead Coordinator. These Coordinators will be invited to a three-day technical assistance meeting scheduled for September 24-26, 2001 in Washington, D.C.

Other National and State Coalition Activities

  • Developed "train the trainer" curriculum by consumers for consumers to assist in becoming informed and active participants in Olmstead planning and implementation. The document will be offered to states as part of technical assistance support.

  • Developing training materials for State Olmstead Coordinators including preparing consumers for facility discharge.

  • Developed a document, with input from the National Coalition, on the barriers faced by persons with mental illness as they transition to the community. A special report on the barriers faced by children is being prepared.

State Planning and Systems Development Branch/Mental Health Block Grant (MHBG). The goals of the MHBG are consistent with the Olmstead decision's goals. Law mandates the MHBG to move the locus of care from institutions to the community. The 2001 National Technical Assistance annual MHBG Conference for state mental health planners, sponsored by the State Planning and Systems Development Branch, will be held August 5-7, 2001, at the Capital Hilton Hotel in Washington, D.C. The conference theme is "Partnerships for Integration: Strategies for Serving Individuals and Families," including topics on the Olmstead Decision and the Coalition initiative.

Protection and Advocacy (P&A) Branch. The P&A Branch works with the National Association of Protection and Advocacy Services to ensure that state P&As take a leadership role to ensure that each state's delivery of long-term care for mental health consumers and other disability groups is consistent with the Olmstead decision and the Americans with Disabilities Act (ADA) integration mandate. An array of training and technical assistance has been provided to P&A advocates and attorneys to further Olmstead implementation and planning.

Consumer Empowerment and Related Activities. CMHS administers two Congressionally mandated laws that require consumer participation in State Mental Health Planning Councils and State Protection and Advocacy Advisory Councils. As a result of these and other developments, CMHS has created an impressive portfolio of consumer-related activities including:

  • Providing leadership on Olmstead implementation including convening meetings on the ADA and employment of persons with psychiatric disabilities, involuntary treatment and electro-convulsive therapy.

  • Coordinating agency-wide anti-stigma and anti-discrimination efforts and the development of a range of anti-stigma materials as well as sponsoring national anti-stigma/discrimination events including the March 2001 national mental health symposium. Spring to Action: A National Mental Health Symposium to Address Discrimination and Stigma. With over 400 mental health experts and consumers, a blueprint for action was developed that states and local communities can use to address discrimination and stigma on lives of people with mental illnesses.

Establishing the CMHS National Advisory Council (NAC) Subcommittee on Consumer/Survivor Issues to advise the NAC on mental health consumer issues.

Working with the MHBG Division National Technical Assistance Center on opportunities and challenges that state cultural competence coordinators face in developing state programs to meet the mental health needs of culturally diverse communities; and publishing Technical Assistance Center, Series No. 1-8 of The Change Agent's Tool Box: What You Need to Know About Promoting Systems Integration to Serve Consumers with Multiple Needs, March 2001.

Funding consumer and consumer-supported technical assistance centers, state consumer networks and knowledge development and application consumer-operated services initiatives.

Supporting consumer-related materials on topics as: managed care, gay and lesbian issues, employment discrimination, co-occurring physical disability issues, recovery, self-care, trauma, advance directives, psychiatric residency training, self-advocacy skills, and internet access.

Knowledge Development and Application Grants

The CMHS Targeted Capacity Expansion Grants help communities develop local cross-agency partnership infrastructures to promote access and coordination of care in such areas as co-occurring mental health and substance abuse treatment, supported employment, supported housing, jail diversion, etc. Community Action Grants support communities in adopting community integration practices. Grants to support Consumer and Family Networking help states and communities create networks focused on developing and financing exemplary community-based services. These programs include an evaluation component to help identify science-based treatment and systems development interventions.

The Consumer-Operated Services Program is a multi-site research initiative to discover to what extent consumer-operated community-based programs, as an adjunct to traditional mental health services, are effective in improving the outcomes of people with serious mental illness.

The Comprehensive Community Mental Health Services for Children and their Families program was implemented in FY 1993 to encourage the development of intensive community-based services based on a multi-agency, multi-disciplinary approach involving both the public and private sectors. Funds are available to states, political subdivisions of states, and Native American tribes or tribal organizations to build upon previously developed infrastructure and provide the array of services required to more fully meet the needs of the target population. The target population is children and adolescents, under 22 years of age, with a diagnosable serious emotional, behavioral, or mental disorder accompanied by disability, which must have been present or is expected to be present for at least one year and require services from multiple agencies. Grants are limited to five years of funding. There is an extensive evaluation on the implementation and outcomes of this service program.

In support of the 2001 Health Care Financing Administration Real Choice Grant solicitation, developed a briefing targeting state authorities and designees including information on evidence-based practices and resources on system change for all age groups.

Center for Substance Abuse Treatment (CSAT)

Given that substance abuse treatment systems funded by the Substance Abuse Prevention and Treatment Block Grants are not institutional in nature, these funds may not be spent in hospital settings. The Block Grant focus is on assisting in closing the gap between persons in need of publicly funded treatment and those able to access it. Olmstead considerations especially come into play for those persons who are multiply affected by psychiatric, developmental and/or physical disabilities. CSAT and CMHS work in partnership on fostering appropriate community-based integrated treatment systems for these populations.

The CSAT National Treatment Plan (NTP), released in November 2000, is SAMHSA's strategic blueprint to reduce in half the number of chronic drug users, illegal drug demand, and drugs in the workplace by 2007 as set forth in the National Drug Control Strategy. NTP, which was developed from a national consensus process through public hearings and comments, is based on a system change paradigm that will apply federal resources including block grant funds toward a commonly accepted, evidence-based model for a continuum of services and care for substance abuse across health, human services, and justice systems. Current and future grants will define and support cross-system consensus on state of the art treatment protocols and methods/measures for continuous monitoring of quality consumer care. A specific example in the implementation of the NTP is CSAT's Community Action Grant Program which funds jurisdictions not for supporting direct service delivery but for adoption of exemplary practices through convening partners, building consensus, and eliminating barriers that will result in adaptation of service models that meet client needs at the most appropriate level of care. The ultimate goal for the consumer is that an individual needing treatment, regardless of the entry point or system he or she enters, will be identified and assessed and then will receive treatment and allied services either directly or though appropriate referral.

The Recovery Community Support program is a grant initiative designed to foster the participation of persons in recovery, their families and other allies in the development of substance abuse treatment policies, programs and quality assurance activities at the state, regional, and local levels.

Agency-Wide Activity

SAMHSA has implemented an agency-wide strategic planning process to address the mental health and substance abuse issues and service needs of aging adults. The process includes obtaining input through discussions with both the agency's federal partners and non-government stakeholders. The outcome will be a three-year strategic plan based on SAMHSA's mission and goals.

Contact Information:

Bernard Arons, M.D., Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Room 17-105, Rockville, MD 20857, (301)443-0001

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