Ha, Ha, Ha, Ha, Ha

There has been a recommendation come out of one of the task forces formed to precipitate the integration of the Mental Hygiene Administration and the Alcohol and Drug Abuse Administration that is surely causing apoplexy for Community Behavioral Health Association members. The Regulation task force has recommended that regulations for mental health and substance abuse providers be scrapped in lieu of mandating that providers secure accrediting from national accrediting bodies like CARF or JCAHO.

A mandate was proposed fifteen years or so ago and CBH fought it because members were afraid of the costs of getting accredited. The state backed off (unfortunately) and only a three or four mental health agencies actually moved forward with accreditation. The dearth of accreditted organizations in Maryland should be an embarrassment to the system but nobody has seemed to mind, even when systems as fragile as North Carolina has mandated accreditation.

A lack of a mandate certainly has been part of the reason ford Maryland's mental health system's mediocrity.

If the decision to mandate accreditation succeeds it will have the following positive effects:

• The Office of Health Care Quality will be able to focus on complaints, incidents, emergent quality of care issues instead of routine regulatory reviews of providers.
• Providers will be held to significantly higher quality of scrutiny by external accrediting organizations.
• There will be more focus on clinical and rehabilitation outcomes rather than process.
• There will be an intensive focus on continuous quality improvement that will benefit persons served.
• Important advocacy issues like the ongoing moratorium on the development of affordable housing will be revealed to external surveyors, hopefully, prompting change.

But CBH members must be shaking in their boots at the possibility. Will CBH make another run at promoting mediocrity by opposing an accreditation mandate?

We will see, but all I can do right now is LMAO!

Shameful

I had the good fortune of attending the United States Psychiatric Rehabilitation Association Advocacy ceremony in Washington, DC a few weeks back. The association uses this opportunity for members to visit legislators on key issues important to rehabilitation and recovery and also to honor national legislators who have contributed to the well-being of individuals in recovery. One of those individuals being honored that evening was Maryland's own Senator Ben Cardin.

Unfortunately, it was very embarrassing for me and should be embarrassing for all Marylanders. There were only four Marylanders at the ceremony. I was one of them and the CEO of USPRA was one of the others.

Shame on the Community Behavioral Health Association for their lack of attendance. This is just another example of how CBH has abandoned psychiatric rehabilitation in the State of Maryland and how impotent it is in advocacy for the practice and for people in recovery.

I did the best I could to congratulate Ben and try to be an ambassador for the state's psychiatric rehabilitation efforts but I was fuming.

Is crawling up the butt of the Mental Hygiene Administration and playing Neville Chamberlain when it comes to tough issues more important for CBH than honoring those who have championed our causes?

No wonder we have such a mediocre mental health system. We've seen the enemy and it is us.

Maryland Medicaid Cuts

If it didn't impact the lives of Marylanders most vulnerable, the recent request for comment by the Maryland Department of Health and Mental Hygiene (are we ever going to move two centuries forward and change that name) would be laughable.

The Mental Hygiene Administration, itself, has been the cause of hundreds of millions of dollars iof unecessary expenses to the state Medicaid budget. Some examples:

• A ten-year moratorium on the development of affordable housing opportunities by community mental health providers that has ultimately driven thousands of individuals to emergency room visits.
• An intense implementation focus on expensive, evidence-based practices that have not been proven to be efficacious in the state and cost the state tens of millions of Medicaid dollars.
• The reduction of psychiatric rehabilitation day program visits for people with severe psychiatric disabilities that has minimized their ability to learn social skills that help them integrate into the community.

These are just a few examples of how an administrative, void of strategic vision, has caused Medicaid expenditures to escalate over the last decade.

Unfortunately, the state provider association and the consumer "advocacy" organization, which is in the pocket of the Mental Hygiene Administration, have been largely ineffective in pushing for the changes that are needed to positively impact the State's Medicaid budget. If the State is truly interested in cutting costs in the Medicaid budget it needs a significant change in the vision, or lack there of, of the leadership of the Mental Hygiene Administration.

I just returned from an open house for a new affordable housing initiative in Baltimore City which is a shining example of the possibilities for creating housing for people with psychiatric disabilities. No one from the Maryland Mental Hygiene Administration attended the event. Why?

Because the administration has failed to understand that affordable housing is an integral part of the recovery process for people with psychiatric disabilities in Maryland. Instead, they have extended a moratorium on the development of affordable housing by mental health providers that has been in effect since 2001.

Despite the best efforts of small housing development providers like the one I attended today, the effects of the moratorium have been ruinous. This is not to mention the advocacy efforts of the state's consumer "advocacy" organization, in the pocket of the Mental Hygiene Administration, who has advocated for the moratorium, yet benefitted from state funding to develop their own housing.

Although it cannot be scientifically connected, emergency room utilization by people with psychiatric disabilities has increased over the decade.

The prohibition, initially based on financial, potential liability, has come back to bite the entire system. The state is looking to cut $40 million dollars in Medicaid savings would do well to look at the major reason for repetitive emergency room visits- housing.

MD budget hearings

I testified at the Senate budget hearing for the Alcohol and Drug Abuse Administration today and the committee was sympathetic and attentive.

What was really interesting, though, were the folks waiting to testify on the Mental Hygiene Budget. You had the lapdog provider association that has, for years, been "Chamberlainesque" in their dealings with the Mental Hygiene Administration for years, failing to protest obvious state violations of the Supreme Court Olmstead Decision and On-Our-Own members, who have forgotten the face of their fathers, don't come close to representing the vast majority of people with psychiatric disabilities and actually advocate for violations of the Olmstead Decision, specifically the moratorium on the development of affordable housing for people with psychiatric disabilities. This, at the same time, as they reap state monies to develop housing themselves. Hypocrites and violators of civil rights at the same time.

Ultimately, though, the problem lies with a lack of vision and leadership at the state level -- state leaders who pat providers on the head for not making waves or filing legitimate civil rights law suits or lining the pockets of "consumer" leaders who pretend to have the best interest of the masses with severe mental illnesses in mind.

In the richest state in the Union can we afford to have these perennial games go on? I would hope not.

But my hope is lagging.

USPRA

I recently returned from the United States Psychiatric Rehabilitation Association annual conference in Boise, ID. Aside from some representatives from MD VA facilities, I was the only Marylander at the conference.

I think that this is a clear sign that the State of Maryland has abandoned any pretense of wanting the practice of psychiatric rehabiliation in the state.

The Mental Hygiene Administration has continually eschewed the acceptance of the CPRP certification for practitioners, effectively thumbing its nose at quality practice in the field.

The Mental Hygiene Administration has blindly pursued the implementation of expensive "evidenced-based practices" such as assertive community teams and supportive employment, spending scarce resources to benefit the few and ignoring the masses.

The Mental Hygiene Administration is in its 9th year of a moratorium of the development of affordable housing by community mental health providers, thereby denying hundreds, if not thousands, of Marylanders from affordable housing opportunities but denying them the opportunity to learn important living skills in the rare opportunities the get for housing.

The Maryland Mental Hygiene Administration, by forsaking strategies to implement and sustain psychiatric rehabilitation, has demonstrated that it is not only strategically bankrupt, but in the case of its housing policy, morally bankrupt, as well.

They woke up?

Apparently, the forced closure of the Upper Shore Hospital in Maryland's eastern shore has caused enough shock to the Maryland Mental Hygiene Administration that they have quietly abandoned their nine-long year moratorium on the development of affordable housing opportunities for people with psychiatric disabilities.

In preparation for the closure of the hospital, contracts have been let for crisis services, intensive intervention services and residential services for those who will leave the hospital.

Those supports have been tested and available for decades. MHA has consistently chosen not to support crisis residential services at adequate rates and supports for individuals in new residential programs.

The failure of the Mental Hygiene Administration to support these established efforts has cost taxpayers, probably, hundreds of millions of dollars and more importantly, an enhanced quality of life for persons served.

Shame on the Mental Hygiene Administration in Maryland for waiting until a budge crunch forced your hand. Shame on the advocacy community for not forcing your hand earlier.

Congratulations to those individuals who will get an opportunity to be full contributing partners in their community because of the closure of the Upper Shore Hospital. You should well-consider your legal options against the state because of their lack of vision.