May 15, 2002
Alaska Mental Health Board
431 N. Franklin, Suite 200
Juneau, Alaska† 99801
Re: Consumers Consortium Response to RFR
Consumers Consortium came together when disparate and exhausted consumer run organizations discovered their common problems and began looking for common solutions.† The consortium has the assumption of commonness rather than the assumption of separation.† We believe that it will be much easier for the MH system to respond effectively to us as a group, working together.† In that spirit, we have come together to build a consensus around the mental health system in response to the Boardís call for input into the budget building process.
One of the "Guiding Principles" for the Mental Health Board in A Shared Vision II is "Consumer Directed Policy Development" and in the last few years, the Board, the Trust and the Division have really made an effort to include consumers in the policy development process.† As a result, consumers now are able to provide very important input into the Request for Recommendations process.† What you will find in our proposals is a slightly different way of looking at things that if adopted will result in many lives being greatly improved from a more cost-efficient system.† This approach fits squarely with all ten of the Guiding Principles in A Shared Vision II:
1. Consumer Centered Services
2. Consumer Rights
3. Consumer Directed Policy Development
4. Comprehensive System
5. Integrative/Collaborative System
6. Strengths Perspective
7. Home and Community Focus
8. Preventive Services
9. Outcome Based Systems
10. Cost Effectiveness
From our perspective, these Guiding Principles are vital for recovery and departure from the system.
Our basic approach is to reduce or end those services that consumers don't want, thereby saving substantial sums, and replace these with much more cost-effective services that consumers do want.† These take the form of the following specific, prioritized budget proposals:
B. Clubhouses and Other Consumer Run Programs (goal: one in every community with a Community Mental Health Center)
Proposal A, Independent Case Management, is the most squarely directed towards saving money on unwanted services.† It will also result in much better outcomes for many, many consumers, bringing accountability to the system through choice.† In other words, there is no better way to ensure accountability then to allow the customer (consumers) the option of choosing something different when things are not working.
Proposal B. Clubhouses and Other Consumer Run Programs, extends one of the most effective, economical approaches that has come into the mental health system in the last two decades.† This recognized, very inexpensive type of program must be expanded in Alaska so that there is at least one consumer run program in each community with a mental health center within the next ten years.
Proposal C. Consumer Policy Development Participation.† The Mental Health Board as well as the Trust are very committed to having meaningful consumer and family input into their policy development processes.† The truth is that unless consumer run organizations can travel to the various meetings of these boards as well as to other important policy development meetings, the opportunity to meaningfully participate is in theory only.
Proposal D. Consumer Transportation is designed to provide consumer run organizations with funding† to operate vehicles which they are able to obtain through donations or grants, or to use the Coordinated Public Transportation Systems such as CARTS. While this category wonít cost the state much, it means a great deal to each consumer run organization. Transportation is a symbol of dignity and self esteem and is invaluable to the interconnection between consumer run organizations and the MH System.† At the last few AMHB meetings, there has been a great deal of comment from consumers about how difficult a problem this is, and this proposal will address this great unacknowledged need.
Proposal E. Flexible Support Services, is specifically designed to prevent serious relapses that would otherwise result in a hospitalization or other bed-connected service.† What we have uniformly found is that many people can do very well, sometimes for quite a long time, and then run into trouble for various reasons and the system absolutely will not respond until the person is so bad that he or she is dragged to API or another inpatient facility, sometimes even in handcuffs.† We know the Flexible Support Services proposal will prevent many relapses and inpatient hospitalizations, will save money, and most important will avoid the gut-wrenching consequences that every hospitalization causes.
Proposal F. Consumer Directed Housing Specialist: All of the research shows that housing is an essential element of recovery. This specialist is needed to be able to personally arrange housing for the very many homeless consumers or those in danger of becoming homeless. It is very important to the success of this approach that the position be directed (employed) by a consumer run agency so that the very critical peer support element can be added to keep people in their housing.†
Proposal G. Consumer Directed Employment Specialist, is for a consumer run agency to have a full-time person working on helping people get employed. After housing, employment is consistently a top priority for consumers.† By having an employment specialist work with and within the peer support environment of a consumer run program, the process will be sensitive and responsive to MH consumerís special needs. Of course, to the extent that people get off disability income and onto the work roles, major cost savings are achieved. Also people who have meaningful work do much better with their mental illness and have much lighter demands on mental health services.
Proposal H. Consumer Directed Criminal Defense Attorney.† There has been a lot of attention in the last few years to "decriminalization," but it is a strange concept as implemented because it is mainly focused on programs in the jails and after jails, but not keeping consumers out of jails.† Anchorage's Mental Health Court is a marvelous program, but a consumer normally has to plead guilty or the equivalent (no contest) in order to participate in the program.† What sense does it make for a major part of the decriminalization effort to require a person to be criminalized to participate?† This is not the court's fault.† The main things that need to be done to keep consumers from being criminalized are:† (1) adequate housing; (2) strong peer-support to help the person from keep from getting into trouble, and (3) good legal representation to prevent the ridiculous things consumers are being convicted of.† The Legal Advocacy part of the Support Education Advocacy and Leadership (SEAL) is a terrific first step, but this is such a big problem that a full-time consumer directed attorney needs to be employed to tackle the situation.† We say consumer directed for two reasons.† First, the consumer run program needs to educate the attorney about what is really going on with the consumers as well as be an interface (interpreter in some cases) between the consumers and the attorney.† Second, the consumers need that peer support to help them stay out of trouble with the law.
Proposal I.† Mental Health Board Housing Specialist.† The Mental Health Board needs a full-time person, based out of Anchorage, working on housing issues. It seems like there are at least three housing policy meetings a week in Anchorage and the Boards participation is notable for its almost complete absence from the process
I. Consumer Clubhouse in Anchorage† The consumer run clubhouse and related programs in Anchorage is seeking matching grants for itís own permanent home.
II.† Consumer Clubhouse in Juneau.† Similarly, the Polaris House consumer run clubhouse program in Juneau needs to find matching grants for a suitable space for their growing program.
III. Consumer Run Housing Projects. There needs to be consumer run housing options available in Alaska. This has been very successful in other places. Relatively small amounts of Trust money can be leveraged through loans and matching funding, probably on about a five to one basis, to provide this kind of housing.† It is being increasingly recognized that in many cases, housing should not be provided by the community mental health center or other service providers. This is a policy objective of the federal Department of Housing and Urban Development (HUD) and the Alaska Housing Finance Corporation (AHFC).† The Consumers Consortium believes that at least a piece of this puzzle need be consumer run via consumer run organizations.
IV. Agricultural Therapy is a demonstration model of how simple meaningful activity can enrich the lives of consumers and their close family members, while providing basic financial rehabilitation.
V. Consumer Run Businesses is to provide capital money to purchase equipment to allow consumers to start businesses.† Consumer run businesses have been very successful in other places and they need this sort of funding to get them going as loans and other conventional sources of funding are normally not available.† As with other employment types of proposals, to the extent that people become self-sufficient in the market place, the financial burden on the mental health system is reduced.
VII. City Sewage Conversion for Parents, Inc. is to repair the building which houses Parents, Inc. so that their ongoing successful programs for mental health Trust beneficiaries can continue. This is an emergency maintenance need which has nowhere else to turn for funding.
While it is very difficult to ascertain what is the mental health portion of the combined four beneficiary group budget bill, it is very clear that only $175,000 (MH Consumer & Family Conference and Cosumr-directed Prog&clubhses) in operating funds is specifically directed towards consumer run programs and maybe half that again ends up in consumer-run projects through the grant process. The Consumers Consortium believes, particularly in this time of budget contraction, that the promise of consumer oriented services and the emphasis on good outcomes for consumers contained in A Shared Vision II and the Trust's In Step plans should become a major initiative, supported by a significant amount of financial support
A summary of our budget Proposals is as follows:
The Consumerís Consortium currently includes the AkMHCWeb, Ionia, NAMI-AK, Polaris House, Circle of Wings, Parents, Inc. and Daybreakís Field of Dreams. These consumer run programs, and the other programs proposed here, have all been proven effective and should be supported as one of three areas of major budget adjustments for this next two year cycle.† The Consortium and its members are also eager to increase our participation in and collaboration with the community mental health centers and other mental health system providers.† We expect to be active as board members and otherwise support and collaborate with them.
The Consumers Consortium feels that in addition to the proposals set forth here, the other two areas that should be emphasized in this budget cycle are rural and children's services.