• Adult Felony Drug Court - A report on the social and economic success of this vital program in St. Louis City
• Community Hospitals: Addressing Behavioral Healthcare Needs - A report by the American Hospital Association, February 2007
• Community Psychiatry
• Crisis Intervention Training (CIT) for Law Enforcement - Information on Training police on how to deal with people who are mentally ill
• Crisis Intervention Training (CIT) for Law Enforcement - June, 2006 Evaluation.
• Grading the States 2006 - Missouri
• Jackson County Mental Health Court (Kansas City, MO vicinity) Demonstrates Success
• Keeping Offenders with Mental Illness out of Jail
• Law Enforcement and People with Severe Mental Illness
• Mental Health Facts
• Mental Health Policies and the Corrections Community
• Mental Health Problems of Prison and Jail Inmates

• Missouri Offender Reentry Program - Slide show
• More Information about the Jackson County Mental Health Court
• Program of Assertive Community Treatment
• Pro-Vote Report on Loss of Medicaid Coverage in Missouri, 2007
• Recovery and Coercion: Reconciling two hotbutton terms
• Report on Illicit Drug Use in the U.S.
• Shifting the responsibility of untreated mental illness out of the criminal justice system 

• St. Louis Region Consumer Report about Behavioral Health Services - St. Louis Regional Health Commission Consumer Focus Group Final Report,  March 2007

• Substance Abuse Facts

• Substance Abuse, Mental Illness, Crime and Incarceration

Grading the States 2006: Missouri (Source: NAMI)

Overall Grade: C-

• Infrastructure: B
• Information Access: F
• Services: D+
• Recovery Supports: B

Missouri is a state in which the legislature has pounded the public mental healthcare system with budget cuts. At some point, cuts mean more than trimming fat or saving money; instead, they become harms, cutting muscle and bone, translating into needless suffering and early deaths.

Missouri already has passed that point.

In 2005, the state cut Medicaid eligibility to 85 percent of the poverty line. Approximately 100,000 people with disabilities lost coverage, about a third of them persons with serious mental illnesses. More cuts are expected.

The Department of Mental Health (DMH) is trying to navigate through the storm, even while leading the nation in some areas.

The state confronts shortages in housing, acute care beds, and community alternatives to hospital care. Solving these problems requires money. The key tosolutions is unquestionably held by the state legislature.

In 2004, the legislature passed mental health insurance parity, an important step which demonstrated some understanding that unless middle class taxpayers have access to care, costs to the public system will increase, as families spend down assets. But greater recognition by the legislature of cost-shifting relationships is still needed. When mental health services are reduced or eliminated, emergency room visits and hospitalizations increase, and in some cases, greater costs are imposed on the criminal justice system.

Missouri's mental health care system is centralized. In a significantly rural state, centralization can lead to complexity. Missouri counties have the option of funding and delivering mental health services on their own, but only St. Louis and 13 of the state's 114 counties actually do. In the face of state budget cuts, this structure contributes to fragmentation, putting rural areas at a disadvantage.

The state uses an approach called "Procovery," a model that other states can learn from.  Procovery focuses not on a return to conditions before the onset of serious mental illness, nor static maintenance, but rather on moving people forward in their lives to the highest possible level. It is pragmatic, holistic, and to some degree spiritual in its outlook.

Missouri also leads the nation in oversight of clinical prescription practices, through a voluntary program for doctors conducted by a collaboration between the Missouri Mental Health Medicaid Pharmacy Partnership (MHMPP) and a private company called Comprehensive NeuroSciences (CNS). The program has reduced hospitalizations and unnecessary poly-pharmacy, and saved the state approximately $8 million in 2004. Equally important, MHMPP is grounded in sound clinical practice, rather than indiscriminate, restrictive formulary approaches. The federal Center for Medicaid and Medicare Services (CMSS) has identified MHMPP as a national model and the American Psychiatric Association (APA) and the Disease Management Association (DMA) gave it their Gold Award for innovation in 2005.

Other states, such as Massachusetts, have their own versions of MHMPP, but the "Show Me" state is the one that has delivered results. It is a national best practice model.

Work is a key to recovery for many consumers. DMH reports that it works with the state's Division of Vocational Rehabilitation to provide vocational services to approximately 18,500 persons. Its first plan was established in 1999 and has been continually revised, reflecting a proactive commitment.

Decriminalization of mental illness is another area of progress. In Kansas City and St. Louis, advocates see police Crisis Intervention Teams (CIT) and jail diversion programs working effectively - but ultimately, their success depends on the availability of community services. 

DMH has initiated a disease management approach to mental illness which includes treatment for physical disorders - such as heart disease and diabetes - which often are interrelated. 

The state has studied its suicide prevention effort and is tracking data.

Death is one harsh, but real, outcome for some consumers. The state needs to continue to study mortality among its service recipients, particularly in light of the cuts in Medicaid and services. Improving mortality data is consistent with DMH's record to date of confronting hard issues honestly, learning from them, and responding creatively. Transparency and accountability are essential to preserve the state's "show me" reputation.

See the scorecard upon which NAMI judges Missouri's mental health conditions.

Good Reading

The Treatment Advocacy Center (www.treatmentadvocacycenter.org) is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses. TAC promotes laws, policies, and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.  We are grateful to TAC for the following resources:

From Catalyst, the publication of the Treatment Advocacy Center:
http://www.treatmentadvocacycenter.org/JoinUs/CatalystArchive/CatalystSpringSummer2006.htm.

The following article appeared recently in SHERIFF magazine, about law enforcement and corrections professionals as nontraditional advocates:
http://www.treatmentadvocacycenter.org/GeneralResources/documents/013107SheriffMagazine.pdf.

There are also some additional materials that you may find helpful: 

-  Stats on law enforcement and people with mental illnesses: http://www.treatmentadvocacycenter.org/BriefingPapers/BP16.htm

-   Oped from CORRECTIONS TODAY, Shifting the responsibility of untreated mental illness out of the criminal justice system: http://www.treatmentadvocacycenter.org/GeneralResources/article130.htm

-   SHERIFF magazine special report (4 articles) – keeping offenders with mental illnesses out of jail: http://www.treatmentadvocacycenter.org/BriefingPapers/documents/113004SheriffMagazine.pdf

St. Louis Regional Health Commission Issues Focus Group Report on Strengths and Weaknesses of Mental Health Services in the St. Louis Area.  Click here for the full report . . .

Loss of Medicaid Coverage in Missouri

When the Governor of Missouri made drastic cuts in Medicaid coverage last year, it affected over 100,000 REAL people. This list was provided by Pro-Vote which has chapters in Kansas City, St. Louis and Springfield.  It shows the number of people cut off Medicaid by county. 

Recovery and Coercion
Reconciling two hotbutton terms
by Treatment Advocacy Center Executive Director Mary T. Zdanowicz, Esq.

Deinstitutionalization was a paradigm shift in treatment of patients with severe mental illnesses – and it was certainly a shift for the psychiatric profession who traditionally treated such patients in hospitals.

The “institutionalization” period stigmatized psychiatrists with the legacy of “forced treatment” that was so vividly portrayed in the movie “One Flew Over the Cuckoo’s Nest.” Along with deinstitutionalization came an expectation that community psychiatrists should be able to treat patients “voluntarily” in the community, despite the fact that before deinstitutionalization, many of these patients would have been hospitalized. One benefit of hospital treatment that was lost in the outrage during the “bedlam” debate is that an inpatient setting also provides an opportunity to leverage treatment in clinically appropriate ways for patients who otherwise would refuse care.

You may read the rest of this article at:
http://www.treatmentadvocacycenter.org/JoinUs/CatalystArchive/CatalystSpringSummer2006

Mental Health Problems of Prison and Jail Inmates
Doris J. James and Lauren E. Glaze
Bureau of Justice Statistics, U.S. Dept. of Justice

At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 705,600 inmates in State prisons, 70,200 in Federal prisons, and 479,900 in local jails. These estimates represented 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates. The findings in this report were based on data from personal interviews with State and Federal prisoners in 2004 and local jail inmates in 2002.  More . . .

Jackson County Mental Health Court (Kansas City, MO vicinity) Demonstrates Success

More Information about the Jackson County Mental Health Court
Click here

Program of Assertive Community Treatment - This program is an effective, evidence-based, outreach-oriented service delivery model using a 24 hour a day, 7 days a week approach to community-based mental health services.  It uses a multi-disciplinary team and  delivers treatment, rehabilitation, and supportive services to consumers in their homes, at work, and in community settings.  Read more . . .