NAMI Michigan

Good morning. I’m David Ballenberger, the board chair of the National Alliance on Mental Illness (NAMI) of Michigan. On behalf of our board and all NAMI Michigan members, I would like to thank you for the privilege of testifying before you on the critical issue of allocation of government funds for the treatment of mental illness.

I acknowledge the challenges you face as you make very difficult choices on the distribution of scarce funding. But we at NAMI believe that the proposed budget contains provisions that would jeopardize the health of individuals who have a mental illness. I also respectfully argue that, in regards to mental health, the budget, if enacted, will actually cost the state far more than it saves.

The 2010 budget would end open access for Medicaid patients to all drugs necessary to treat their mental illnesses. Instead, it would institute a preferred list of medications and policies of prior authorization, actions that would limit patient access to medications vital to achievement and maintenance of mental health.

Preferred lists and prior authorization can jeopardize patient health by limiting doctors’ freedom to craft the best treatment possible for their patients. Prior authorization gives final control of medication decisions to individuals unfamiliar with specific cases that can prevent individuals from receiving the medications essential to their health.

In studies done in other states, medication access problems caused by preferred lists and prior authorization have been proven to cause discontinuity in treatment and sometimes even complete stoppage of treatment. Discontinuity and stoppage of treatment lead to crises for individuals with mental illness such as psychiatric hospitalizations, Emergency Room visits, homelessness, increases in suicidal and violent behavior, and incarceration. A crisis of this nature is devastating and dangerous for the individual suffering it, but it is also damaging and costly for the entire community. If it enacted the 2010 budget as it is now written, the State of Michigan would save a limited amount on pharmaceuticals, but it would spend excessive amounts on these negative, unintended consequences of prior authorization and a preferred list. The 2010 budget prioritizes minimal short-term savings at an enormous long-term cost.

Another issue I wish to address is the slashing of funding to mental health courts. As you are well aware, the incarceration of individuals who are diagnosed with a mental illness is a crisis in the State of Michigan. Our jail beds are filled with individuals whose only crime was not receiving timely treatment; our Corrections budget is bloated with the funding needed to house these individuals, funding that could be redirected in positive and productive ways. Treatment of mental illness in jails and prisons is often inadequate or nonexistent. NAMI receives ongoing reports of inhumane treatment of the mentally ill in jails and prisons across the state.

The nine pilot mental health courts currently established or being established in the State of Michigan are powerful and innovative tools for treating mentally ill individuals and diverting them from incarceration. These courts use their authority to oversee and direct comprehensive treatment plans, developed and implemented by Community Mental Health, for individuals who suffer from serious and persistent mental illness and whose mental illness has resulted in involvement with law enforcement. Instead of being jailed, which most likely would result in worsened mental health, these individuals are given the opportunity of receiving quality treatment so that they can start over, transform their lives, and eventually reenter the community as healthy and productive citizens.

Loss of funding could result in the collapse of many of these fledgling courts. Mental health courts are merely one step in addressing the massive problem of incarceration of the mentally ill. However, their development is a very positive step and deserves the unqualified support of elected leaders as well as the entire community.

The general cuts to funding for the treatment of individuals who are not covered by Medicaid are another example of policy that does not make sense either for promoting quality care for individuals with mental illness or for saving the state money. Quality treatment is not only an ethical imperative, but it also makes economic sense. Mental illnesses going untreated leave individuals incapacitated, changing them from wage earners and consumers into dependents on social welfare or even prisoners, results that exact a huge financial burden. Cutting back on treatment for individuals treated by Community Mental Health Services but not covered by Medicaid will result in expensive ER trips and costly psychiatric hospitalizations CMHs will be forced to pay for far more expensive crisis response. By rejecting cuts to Community Mental Health Services for individuals not covered by Medicaid, legislators can advance the health of the general Michigan workforce and enable it to realize a prosperous financial future. An investment in mental health treatment is an ethical obligation to our state and our communities that would also pay for itself many times over.

NAMI supports open access to all medications necessary to treat mental illness for individuals treated under Medicaid. NAMI opposes cuts to funding of the treatment of individuals not covered by Medicaid; we are convinced that such cuts to access and general funding will result in personal disaster for many individuals, as well as a worsened financial crisis for the State of Michigan in the future. NAMI also supports mental health courts, which are a creative and significant new way of addressing the crisis in our criminal justice system caused by the incarceration of individuals with mental illness.

Thank you for the opportunity to comment on such vital issues.

David Ballenberger
Chair of Board of Directors
National Alliance on Mental Illness (NAMI) of Michigan