Public Policy Issues

How the mental health system works in Utah:

The Role of the Division of Substance Abuse and Mental Health (DSAMH)

• The DSAMH is the Single State Authority for public substance abuse and mental health programs and is charged with ensure that prevention and treatment services are available throughout the State.
• The DSAMH contracts with the local county government authorities designated by statute to provide prevention and treatment services.
• The DSAMH monitors and evaluates the effectiveness of the services provided and provides technical assistance to the local authorities.
• The DSAMH provides supervision of the administration of the Utah State Hospital.

For information about the Utah State Division of Substance Abuse and Mental Health, click here: http://www.hsmh.state.ut.us/

The Role of the Local Authorities

• Under Utah law, local substance abuse and mental health authorities are responsible for providing services to their residents.A local authority is generally the governing body of a county. Some counties have joined together to provide services for their residents.
• There are 29 counties in Utah, and 13 local authorities. By legislative intent, no substance abuse or mental health center is operated by the State. Some local authorities contract with community substance abuse centers and mental health centers to provide those services.
• Local authorities receive state and matching federal funds to provide comprehensive substance abuse and mental health services, but they are also required by law to match a minimum of the state general funds.

For information about the local substance abuse and mental health providers, click here: http://www.uacnet.org/ubhn/members.php

NAMI Utah positions on a variety of Public Policy Issues

This section outlines NAMI Utah positions on a variety of Public Policy Issues, including Assertive Community Treatment, Supported Employment, Medication Algorithms, Integrated Dual Diagnosis Treatment, Family Pychoeducation, Self Management, Mental Health Courts, Jail Diversion Programs, Supported Housing, and Restraints and Seclusion.

To get up-to-date information on NAMI National Public Policy, please click here.
To view NAMI National's Public Platform, please click here.

Assertive Community Treatment (ACT)

ACT is defined as: a multi-disciplinary clinical team approach to provide intensive in vivo community treatment, support and rehabilitation services on a time unlimited basis to individuals who experience the most intractable symptoms of severe mental illness and who often experience the greatest functional deficits. Phillips, et.al, (2001) identifies 10 principles of ACT: (1) services are targeted to a specific group of individuals with severe mental illness; (2) rather than brokering services, treatment, support, and rehabilitation services are provided directly by the ACT team; (3) team members share responsibility for the individuals served by the team; (4) the staff-to-consumer ratios is small (approximately 1 to 10); (5) the range of treatment and services is comprehensive and flexible; (6) interventions are carried out at the locations where problems occur and support is needed rather than in hospital or clinic settings; (7) there is no arbitrary time limit on receiving services; (8) treatment and support services are individualized ; (9) services are available on a 24-hour basis; (10) the team is assertive in engaging individuals in treatment and monitoring their progress.

Supported Employment

Supported employment programs typically assist people in obtaining competitive e mployment-that is, community jobs paying at least minimum wage for which any person can apply-in accord with client choices and capabilities, without requiring extended prevocational training. Unlike other vocational approaches, supported employment programs do not screen people for work readiness, but help all who indicate they want to work; they do not provide intermediate work experiences, such as prevocational work units, transitional employment, or sheltered workshops; they actively facilitate job acquisition, often sending staff to accompany clients on interviews; and they provide ongoing support once the client is employed.

Medication Algorithms

A medication algorithm translates the latest available knowledge about medications into practical pharmacotherapy suggestions and promotes the optimal recovery in the consumer population. A central objective of the algorithm is to optimize pharmacotherapy for consumers and clinicians via a consensus of patient experience, research evidence, expert advice, practitioner knowledge, and supportive technology (i.e., computer-based).

Integrated Dual Diagnosis Treatment (MI/SA)

Dual diagnosis treatments combine or integrate mental health and substance abuse interventions at the level of the clinical encounter. Hence, integrated treatment means that the same clinicians or teams of clinicians, working in one setting, provide appropriate mental health and substance abuse interventions in a coordinated fashion. In other words, the caregivers take responsibility for combining the interventions into one coherent package. For the individual with a dual diagnosis, the services appear seamless, with a consistent approach, philosophy, and set of recommendations. The need to negotiate with separate clinical teams, programs, or systems disappears. The goal of dual diagnosis interventions is recovery from two serious illnesses.

Family Psychoeducation

Offered as part of an overall clinical treatment plan for individuals with mental illness to achieve the best possible outcome through the active involvement of family members in treatment and management and to alleviate the suffering of family members by supporting them in their efforts to aid the recovery of their loved ones. Family Psychoeducation programs may be either multi-family or single family focused. Core characteristics of family psychoeducation programs include the provision of emotional support, education, resources during periods of crisis, and problem -solving skills.

Self-Management

Includes a broad range of health, lifestyle, and self-assessment and treatment behaviors by the individual with mental illness, often with the assistance and support of others, so they are able to take care of themselves, manage symptoms, and learn ways to cope better with their illness. Self management includes psychoeducation, behavioral tailoring, early warning sign recognition, coping strategies, social skills training, and cognitive behavioral treatment.

Mental Health Courts

Mental health courts are adult criminal courts that have a separate docket dedicated to persons with mental illnesses, divert criminal defendants from jail into treatment programs, monitor the defendants during treatment and have the ability to impose criminal sanctions for failure to comply.

Jail Diversion Programs

Jail diversion programs are specific programs through which some type of mental health intervention places people with mental illnesses in the community instead of keeping them in jail. Individuals with mental illnesses may be identified for diversion from the criminal justice system at any point, including pre-booking interventions (before formal charges are brought) and post-booking interventions (after the individuals has been arrested and jailed).

Supported Housing

Individuals live in their own home (room, apartment, or other location) and receive supportive clinical and psychiatric rehabilitation in order to maintain their stability in the community. Services are available at mental health facilities or can be brought to the individual in their home setting when needed. Disputes with landlords and other tenants are addressed through interventions and social skills training.

Restraints and Seclusion

The use of involuntary mechanical or human restraints or involuntary seclusion is only justified as an emergency safety measure in response to imminent danger to a patient or others. These extreme measures can be justified only so long as, and to the extent that, an individual cannot commit to the safety of him or her-self and others.

Restraint and seclusion have no therapeutic value and should be used only for emergency safety by order of a physician with competency in psychiatry or a licensed independent mental health professional (LIP). A physician trained in psychiatry or a LIP should see the patient within one hour after restraints are initiated. Restraints should be continued only for periods of up to one hour at a time and a face-to-face examination of the patient by the physician or LIP must occur prior to each time a restraint order is renewed.

Alternatives to the use of restraint and seclusion should be used. De-escalation techniques and debriefings should be used after each restraint and seclusion incident.

New Freedom Commission Report