News Briefs

Bazelon Center’s analysis of firearm homicides and psychiatric bed availability: Homicides involving the use of firearms—notably, mass murders that generate significant media attention—have raised questions about the adequacy of U.S. mental health services. Some have argued that the closure of state hospitals is a contributing factor in these murders. In the wake of mass homicides, increasing the number of psychiatric hospital beds appears to be a straightforward response. A recent analysis conducted by the Bazelon Center for Mental Health Law examined the relationships between states’ rates of murder by firearms, incarceration, and the availability of psychiatric hospital beds. If expanding the number of psychiatric beds is a meaningful remedy to firearm-related murders, one would expect a clear association between these factors, showing that states with fewer psychiatric hospital beds have higher rates of firearm-related homicides or incarceration. The analysis found that correlations among these factors are strikingly low. The analysis suggests that to the extent that unaddressed needs of people with serious mental illness contribute to the nation’s homicide rate, the public policy answers lie not in increasing the number of psychiatric hospital beds, but elsewhere. The six-page analysis, which includes breakdowns of findings by state, is available on the Bazelon Center’s Web site at www.bazelon.org.

Developing quality-of-care measures for integrated care of “dual eligibles”: States are working to improve integration of care for individuals eligible for both Medicare and Medicaid, but states face challenges in demonstrating how the new models improve the quality of care. These challenges exist whether the state uses a fee-for-service or a managed care model to improve care delivery. New opportunities provided by the Affordable Care Act to integrate care for this group have heightened state and federal interest in identifying the best approaches to quality measurement. A new brief from the Center for Health Care Strategies, a nonprofit resource center dedicated to improving health care for low-income Americans, summarizes efforts to develop quality-of-care measures for this subgroup of beneficiaries. It provides guidance to states in developing measurement approaches for proposed integrated programs, including assessment of quality in specific domains of integrated care such as behavioral health services. It also describes how performance measures can be shaped by stakeholder input. The 28-page brief, Quality Measurement in Integrated Care for Medicare-Medicaid Enrollees, is available on the center’s Web site at www.chcs.org/usr_doc/Quality_Measurement_in_Integrated_Care.pdf.

NASMHPD report shows strong benefits to states of joining the ACA Medicaid expansion initiative: The National Association of State Mental Health Program Directors (NASMHPD) has conducted an evaluation of several policy studies that shows a substantial positive fiscal impact for states choosing to expand their Medicaid program under the ACA. The analysis predicts total state budget gains up to $300 billion between 2014 and 2023. The significant budget gains resulting from the Medicaid expansion are due to seven major policy initiatives that primarily transfer costs from the states to the federal government under the ACA, including costs for uncompensated care and mental health costs. States will also see increased revenues flowing through their economies as a result of a “multiplier effect,” in which several businesses benefit from the infusion of new Medicaid dollars. A total of 13.4 million people with serious mental illness and other behavioral health conditions will obtain coverage through the expansion and the new state health insurance exchanges. “The Medicaid expansion makes sense for states to opt into the new program,” said Robert W. Glover, Ph.D., NASMHPD’s executive director. “And with the federal government picking up nearly $40 billion in mental health services, this will be a major opportunity to restore monies that have been cut to the state public behavioral health care systems over the last ten years.” Between 2009 and 2012, state mental health agencies have incurred nearly $5 billion in funding cutbacks to programs serving people with serious mental illness. The 108-page policy analysis, The Waterfall Effect: Transformative Impacts of Medicaid Expansion on States, is available on the NASMHPD Web site at www.nasmhpd.org/Publications/NASMHPDPublications.aspx.

CSG Justice Center’s curriculum for developing a mental health court: The Justice Center of the Council of State Governments (CSG) has released a free online multimedia curriculum for individuals and teams interested in starting a new mental health court or retooling programs already in operation. Individuals joining existing programs will also find it helpful. “Developing a Mental Health Court: An Interdisciplinary Curriculum” was created by the CSG Justice Center with the support of the Bureau of Justice Assistance. It provides information that teams need to translate current research and best practices from the field into program design and operation. Its multimedia content includes interviews with researchers, judges, court managers, program coordinators, treatment providers, probation officers, and other experts. A video follows a real mental health court team through common situations. The curriculum is designed for use by a variety of practitioners, including judges; probation, pretrial, and law enforcement officers; prosecutors and defense attorneys; court managers; state judicial educators; mental health and substance use treatment providers and administrators; and case managers. Organized into freestanding modules, it can be customized for users’ specific learning needs and time considerations. Although the full curriculum is designed to take about 32 hours, groups can also use portions of the curriculum to complement existing knowledge. Extensive resources are also available on the Web site to help users make the most of the curriculum and to guide training coordinators and facilitators. The curriculum is available on the Justice Center’s Web site at learning.justicecenter.csg.org.