State innovations and best practices should be replicated

While many states received low grades from the National Alliance on Mental Illness for their state mental health systems, they often had some outstanding examples of innovation and commitment to providing high-quality services to people living with mental illness. NAMI said these examples "demonstrate the pioneering approach that is necessary to fundamentally change America's mental health system. There is an urgent call for our nation to take steps to make these new programs the norm, not the exception," NAMI said.


— California's Proposition 63 in which voters recognized a need to creatively fund services

— Combining multiple funding sources as in New Mexico to streamline care and decision making

— Local municipalities taking the lead to address mental health concerns in their communities through special tax districts or unique bond proposals (Arizona and California)


— Tennessee is cited for tremendous progress in developing housing from almost none in NAMI's 1990 report to among the best today.

— Illinois is using real estate transaction fees to promote rental housing assistance.

— Passage of legislation dedicating $200 million to create 10,000 units of new supported housing in the next 10 years occurred in New Jersey.

— New York State has an initiative to develop more than 36,000 supportive housing units.

— Minnesota has a cooperative program between the state mental health agency and the housing finance agency to provide $650,000 in housing subsidies for people with serious mental illness.

Restraint and seclusion reduction

— The leadership of the National Association of State Mental Health Program Directors drives a national culture change.

— There have been significant reductions in use of restraint and seclusion in a forensic setting at North Texas Hospital in Texas and Taylor Hardin Secure Medical Facility in Alabama.

— Regulations were enacted this year in Massachusetts to codify a preventive approach and discourage using restraint and seclusion in all acute and state-run facilities.

Jail diversion

— Ohio has a culture of jail diversion that permeates almost the entire state.

— Legislation has been proposed in Kentucky to mandate a telephone triage system to screen jail inmates for mental illness and provide links to treatment.

— Connecticut has extensive post-booking jail diversion programs in arraignment courts.

— Maryland has the TAMAR (Trauma, Addictions, Mental Health, and Recovery) program for treating female consumers in detention centers.

— NAMI Indiana runs a prison education program supported by state agencies to educate prison guards and staff about serious mental illness.

— Texas has mandatory jail diversion for every county.

— Georgia and Texas are implementing statewide police crisis intervention training.

Employment/Vocational success

— Five states — Connecticut, Maine, Missouri, New Mexico, and Vermont — received excellent scores in the NAMI survey for their work in employment.

— South Dakota is dedicated to employment opportunities, despite being a rural state, and has a 41% employment rate for consumers.

Disaster Response

— Mississippi, Louisiana, Alabama, and Texas are credited for quick response and triage to continue service provision and ensure safety of consumers during and after Hurricane Katrina.

— Mutual aid support from many states across the country.

Academic/State collaboration

— Ohio, Hawaii, and Indiana are partnering with SMHAs and universities to establish centers promoting implementation of evidence-based practices.

— Connecticut is collaborating with Yale University to promote the mental health care work force.

Creative use of public land

— There is a public/private collaboration to rebuild a community mental health center in Massachusetts.

— Oregon is reinvesting funds from sale of a state hospital to create increased housing options for individuals with mental illnesses through the Community Mental Health Housing Fund.

— Alaska has established a Mental Health Trust Authority to generate revenue for the state's mental health services.

Mortality studies

— Medical directors from the National Association of State Mental Health Program Directors are investing in mortality studies as a priority.

Multicultural outreach

— State leadership in California is encouraging and monitoring county-based efforts to ensure culturally competent care.

— Arizona is working to ensure the mental health work force has appropriate linguistic skills, and that materials are properly transmitted.

— Washington is establishing subcommittees — specifically on ethnic/cultural minorities and sexual minorities — to focus on the impact that legislation, public policies, and practices have on treating multicultural and/or minority groups in institutional, residential, and community

Co-occurring systems change

— Oklahoma is developing a consumer- and family-driven process to evaluate every level of the system to integrate services for co-occurring disorders.

— Leadership to integrate treatment for substance abuse and mental illness, resulting in statewide adoption of integrated dual disorder treatments in Delaware.

— State-funded programs in Georgia to incorporate mental health treatment principles into a traditional 12-step model.

Capacity response

— Arkansas is using its authority to generate new inpatient beds to address a profound population need.

Parity Laws

— Connecticut, Maryland, Minnesota, and Vermont have a model parity law that includes substance abuse.

— Maine is including mental health parity in a statewide program to expand health insurance to uninsured populations.

Clinical approaches to Medication access

— Missouri has a program to provide clinical feedback to doctors on prescribing patterns that save money and improve outcomes.

Peer support/peer-run programs

— Vermont has a culture infused with recovery principles.

— Connecticut has policies to promote recovery and ensure it is a part of the state's mission and treatment planning.

— Georgia provides Medicaid reimbursement of certified peer counselors.

Health Promotion

— New Hampshire is developing a program that provides identification and intervention for diabetes, hypertension, and other cardiac risk factors among individuals with serious mental illnesses.

Community system of care

— Comprehensive systems of care with demonstrated linkage between service providers and integrated services and approaches (Vermont and Wisconsin).

Engaging Rural Constituents

— Use of audiovisual technology to eliminate long-haul vehicle transport for Oklahomans in needs of emergency detention orders.

— Nebraska is taking a deliberate and deliberative approach to system redesign to improve local service capacity and access within specific budgetary restraints.