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Change Coming For Public Mental Health

There’s big change on the horizon for the public mental health safety net. The Excellence in Mental Health Act is being called the "biggest federal investment in mental health and addiction services in generations."

To discuss the changes, and to learn how Missouri’s mental health system has fared since federal funding was rolled back for Community Mental Health Centers, KBIA sat down with Brent McGinty, President and CEO of the Missouri Coalition for Community Behavioral Healthcare.

This interview has been condensed and edited for content and clarity.

Back in the ‘80s, there was basically [the federal Community Mental Health Center] designation that went away and went into block grants for the states. So instead of the way we used to be designated where the federal government could impact policy on the Community Mental Health Center level, that all was just rolled into a big block grant given to the states and said, ‘states, take over all the mental health funding.’ And it’s really up to the states to settle their mental health policy and the results of that have been uneven at best across the country.

Q: So what did we do and how did we do in Missouri?

We did very well in some areas and not so well in others. I think the state of Missouri needs to be commended in its public mental health system. It’s really a leader in the nation in making sure we treat the whole person.

As we learned through research that was done 5-6 years ago now, individuals with serious mental illness were dying 20-25 years earlier than the general population. Not because they had a mental illness, but because they had chronic health conditions, chronic diseases that no one was paying attention to. And these folks were not getting the services that they needed.

We realized that was not enough anymore. So our disease management program, our health care homes programs, all are considered national models on really integrating the care of mind and body.

On the negative side in Missouri we have not expanded Medicaid. So because of our low eligibility levels, what our system has in place right now is a crisis driven model where we ask those with serious mental illness to become fully disabled before there’s a payer for them.

Research is showing that if you can engage in the earliest point of that psychiatric illness, the recovery can be remarkably better, the treatment cost remarkably lower, then if you wait until they have many, many psychotic breaks and get full on into their illness before you start that treatment.

Q: Why does it make sense for Missouri to participate in the Excellence in Mental Health Act?

The Excellence in Mental Health Act was really targeted in several ways to really build upon what we’ve already done in Missouri. So it brings back the federal designation, it requires new evidence based practice requirements, new accountability and outcome measures.

Once this gets fully up and running across the country, like we hope it does, the federal government will finally have data on the mental health safety net across the country. And that will be a good place to get to because we can start really doing some systematic improvements. 

Copyright 2015 KBIA

A curious Columbia, Mo. native, Bram Sable-Smith has documented mbira musicians in Zimbabwe, mining protests in Chile, and the St. Louis airport's tumultuous relationship with the Chinese cargo business. His reporting from Ferguson, Mo. was part of a KBIA documentary honored by the Missouri Broadcasters Association and winner of a national Edward R. Murrow Award. He comes to KBIA most recently from the Salt Institute for Documentary Studies in Portland, Maine.
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