ACT: reform is "easy" Once you realize there is No quick fix
TO PARAPHRASE JOHN LEGEND:
PROVIDE THE INTENSIVE COMMUNITY MENTAL HEALTH TREATMENTS PEOPLE NEED NOW
For Some-- taking medication can be like pouring oil all over their mental engines --- yes some gets into the right place, and all over one's mental engine block in some cases doing more harm than good. ---see Caltech Neuro-scientist David Anderson's TedxTalk below.
The Bottom Line: Our Brains Are More Than Bags of Chemical Soup.
How Minnesota does it.
It's Medicaid: You Knew It Was Going To Be Complicated -- It's A Mixed Bag
A Tale of Two States:
ACT: Colorado & Minnesota
What makes Assertive Community Treatment so effective is that it is pretty much everything and the kitchen sink, including:
[Parenthetically, some of that such as supported employment which isn't covered by Medicaid is often included in US Dept. of Justice Olmstead Settlement Agreements]
What is a State to do?
Well, for most States, including Colorado, if Medicaid, doesn't pay for all of it, the State isn't going to either.
Medicaid does have what it calls Non-Medicaid Services Waivers to help fund what Medicaid won't fund with respect to things like supported employment, unfortunately Colorado has it funding everything ACT.
Additionally, the money for Colorado's Non-Medicaid Services Waiver is limited to the "savings" from Colorado's Medicaid Mental Health Managed Care Program -- and the services are not entitlements. (See 1915(b)(3) Non-Medicaid Services Waiver
Our understanding is that Colorado has also tried to increase its ACT capacity through the Colorado Dept. of Human Services and the acquisition of various grants. We think that very praiseworthy.
AND the Bottom Line for people needing intensive community mental health treatment in Colorado, Assertive Community Treatment which is the Gold Standard in intensive community mental health treatment is NOT an entitlement in Colorado. That really is crazy.
AND in fact that is not the only way to do it. Minnesota provides ACT as a "rehabilitative service." We were originally concerned that ACT as a rehabilitative service might be too limiting but we were pleasantly surprised to see how Minnesota defines this:
"The U.S. Psychiatric Rehabilitation Association defines psychiatric rehabilitation as services that promote “recovery, full community integration and improved quality of life for persons who have been diagnosed with any mental health condition that seriously impairs their ability to lead meaningful lives.
"Psychiatric rehabilitation services are collaborative, person directed and individualized. These services are an essential element of the health care and human services spectrum, and should be evidence-based.
"They focus on helping recipients develop skills and access resources needed to increase their capacity to be successful and satisfied in the living, working, learning, and social environments of their choice.”
(Note that Minnesota provides supplemental grants to ACT teams to support activities that are necessary but not Medicaid-reimbursable.)