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Commentary: State progress in mental health care threatened

Most Minnesotans may be surprised to learn that despite Minnesota's reputation as a health care leader, the state's mental health system received only an average ranking in a national study released this month. At the same time, state budget cuts may threaten this status, cutting access to mental health services and thwarting progressive strides made in the state's mental health system in recent years.

According to the National Alliance on Mental Illness' latest report card -- "Grading The States 2009: A Report On America's Health Care System For Adults With Serious Mental Illness" -- Minnesota's public mental health care system received a grade of C, the same grade received since NAMI's initial measurement in 2006. Minnesota fared better than the national average that has remained at a D since 2006, reflecting that the country remains largely stagnant in improving a mental health care system that a presidential commission condemned as an inadequate, outmoded "system in shambles."

The report recognized the significant investment in 2007 in the infrastructure of Minnesota's mental health system, where funding was obtained for crisis teams, supportive housing, crisis intervention training for police, culturally diverse providers and evidence based practices. The common benefit set across all Minnesota health care programs was also praised as a great innovation.

This initiative added more mental health sbenefits to the Medical Assistance, MinnesotaCare and General Assistance Medical Care government-sponsored health programs, shifting costs for the provision of these services to the state and federal governments and away from counties. In turn, the Legislature enacted a Maintenance of Effort mandating that county funds freed up as a result of this cost-shifting would continue to be used for much-needed mental health services not covered by these safety-net programs.

While the state has made some progress, Minnesota's C ranking demonstrates that the state has a long way to go before we have a system that truly provides mental health services when and where they are needed. Most troubling is that the very innovation that brought praise -- the common benefit set -- is being threatened in the governor's budget proposal.

The governor's plan calls for the elimination of MinnesotaCare for adults. More than 88,000 people (of whom 30 percent use mental health services) would lose their health insurance. The impact that such cuts would have on providers, including inpatient hospitals, would actually increase costs as people will enter the system in worse condition without access to help sooner.

In addition, the state-mandated MOE is also under scrutiny. These county funds provide community-based services that focus on early intervention for residents who are uninsured or underinsured. Many community-based programs depend on these funds for their viability. In fact, Minnesota counties now spend $111 million on mental health services; that's nearly 25 percent of all dollars spent on mental health care.

As the need for these services rises during this economic downturn, it is crucial that Minnesota lawmakers continue their support of the existing infrastructure now in place for mental health services. Eliminating or greatly reducing these dollars will result in the collapse of our mental health system when we need these services more urgently than ever. We simply cannot allow the budget crisis to steer us so far off course.

Sue Abderholden is executive director National Alliance on Mental Illness of Minnesota.