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					Mental Health Association (MHA)                                              (301) 424-0656
Serving Montgomery County, Maryland                                           Volume 9, Issue 1


   1. Access to the Public Mental Health System
   2. Integrated and Coordinated Early Childhood and School-Based Mental Health Services
   3. Juvenile Justice System Reform
   4. Affordable Alternative Housing Options for People with Mental Illness
   5. Subscription Information & Action Alert information

National Status Report

Legislative Update
      The Senate Health, Education, Labor and Pensions (HELP) Committee is scheduled to consider
          legislation to reauthorize the Substance Abuse and Mental Health Services Administration
          (SAMHSA) on January 30, 2008. The draft bill includes the following initiatives: expansion of
          suicide prevention programs; prevention of custody relinquishment; services for homeless individuals
          with mental illness; and efforts to further reduce the use of restraint and seclusion of young people.
          (NAMI E-news, 1/18/08)
      Mental health reform is a top issue before the Virginia General Assembly. For months lawmakers
          have been educating themselves on the complexities of mental health law. Rep. Phil Hamilton
          introduced a bill that is seen as a major piece of legislation because it addressed both judicial and
          health concerns that came out of the Virginia Tech tragedy. (Article by Hugh Lessing

News and Noteworthy
    About 9 percent of U.S. troops who have performed combat duty in Iraq and Afghanistan report
        experiencing post-traumatic stress disorder, according to a study by Defense Department researchers.
        The study, published 1/15/08 in the British Medical Journal, provides the latest estimate of this
        mental disorder among U.S. troops returning from those wars. The study tracked PTSD among
        approximately 50,000 U.S. troops, looking at differences in rates among those who saw combat,
        those who deployed in noncombat roles and those who did not deploy. Some troops develop PTSD
        after wartime trauma such as suffering wounds or witnessing others being hurt. It often appears
        months or years after a traumatic event. The researchers wrote, ―The unpredictability and intensity
        of urban combat, constant risk of roadside bombs, multiple and prolonged tours, and complex
        problems of differentiating enemies from allies can leave many troops with high stress levels and
        possible lasting health consequences.‖ (Reuters, 1/15/08)
    The Department of Defense Mental Health Self-Assessment (MHSA) Program is a mental health and
        alcohol screening and referral program provided for military families and service members affected
        by deployment and mobilization. The voluntary and anonymous program is offered online, by
        phone, and through special events held at installations and reserve units. Individualized results and
        military health resources are provided at the end of every assessment. Individuals can bring the
        results of their online or in-person assessment with them to a health care provider. The MHSA
        Program is available at The MHSA program is part of the

        Department of Defense continuum of care fully funded by Force Health Protection and Readiness,
        Office of the Assistant Secretary of Defense, Health Affairs. There is no charge to military families,
        installations, or units to use these tools. (Deployment Health Clinical Center, DHCC Daily News,
       U.S. Senators Benjamin L. Cardin and Barbara A. Mikulski (Both D-MD) have co-sponsored
        legislation designed to ensure that Maryland and other states receive proper reimbursement from the
        federal government for medical and social services provided to children and families with complex
        health-care needs. The bill, S.2578, would place a moratorium until April 2009 on proposed federal
        regulations that limit the scope of federal health-care reimbursements, and it would ensure that states
        receive adequate funding for services known as "targeted case management.'' (Cardin, Mikulski Press
        Release January 31, 2008)

State Status Report

Legislative Update
      Governor Martin O’Malley announced his proposed budget on January 16, 2008. He highlighted the
          themes of ―Workforce Creation,‖ ―Sustainability,‖ and ―Public Safety Integration.‖ He has
          highlighted initiatives such as a freeze in college tuition, programs promoting ―Smart Growth,‖ and
          improvements in the supervision of high-risk offenders on parole and probation. The Governor also
          points to a $20 million increase for service providers. The budget generally follows the plan laid out
          in the special session. It reduces the state’s structural deficit by relying on the increased tax revenue
          from the special session and $550 million in cuts from the planned spending levels. The budget
          totals $31.6 billion, a $1.9 billion increase over this year’s appropriation. Total spending increases
          5.9% over the current year. A structural gap is projected to persist until 2012, when significant slot
          machine revenue is forecast to bring the budget into long-term balance. (Special Report, Maryland
          Budget & Tax Policy Institute, 1/17/08)

Legislation introduced pertaining to access to the Public Mental Health System
      SB 26 Task Force to Study the Commitment of Sexually Violent Predators to Facilities of the
          Department of Health and Mental Hygiene: The bill would establish a task force to study the
          commitment of sexually violent predators to DHMH facilities. The bill is sponsored by Senator
          Simonaire and assigned to Judicial Proceedings.
      SB 45 State Advisory Council on Quality Care at the End of Life – Membership: The bill
          would establish a State Advisory Council on Quality Care at the End of Life. The bill is sponsored
          by Senator Lenett and assigned to Finance.
      SB 82 State Lottery – Compulsive Gambling Grants: The bill would establish a special fund to
          provide grants to address the problem of compulsive gambling in the State; requiring that the
          Secretary of Health and Mental Hygiene issue specified grants to address the problem of compulsive
          gambling in the State; establishing the purpose of a specified pilot project; specifying the use of
          funds; and providing for the termination of the Act. The bill is sponsored by Senators Klausmeier,
          Colburn, and Kelley and assigned to Education and Environmental Affairs.
      SB 83 Commission on Gambling Addictions: The bill would establish a Commission on
          Gambling Addiction in the Department of Health and Mental Hygiene; providing for the
          membership, terms, quorum, and meetings of the Commission; specifying that the purpose of the
          Commission is to study the effects of individuals who are addicted to gambling, to measure the cost
          of gambling addiction, and to propose specified solutions, etc. The bill is sponsored by Senators
          Klausmeier and Colburn and assigned to Finance.
      SB 210 Maryland Veteran’s Behavioral Health: The bill would establish behavioral health service
          coordination among the Department of Health and Mental Hygiene, the United States Department
          of Veteran Affairs, the Maryland National Guard, and the Maryland Defense Force for veterans of
          the Afghanistan or Iraq conflicts, etc. The bill is sponsored by The President (By Request –

        Administration) and Senators Astle, Brochin, Currie, Della, Edwards, Frosh, Garagiola, Gladden,
        Kasemeyer, King, Klausmeier, Lenett, Madaleno, Peters, Rosapepe, and Stone and assigned to
       SB 242 Department of Health and Mental Hygiene - Developmental Disabilities and Mental
        Health Services - Cost-of-Living Adjustment: The bill would require in FY08 the Department of
        Health and Mental Hygiene to use updated factors by the Community Service Reimbursement Rate
        Commission to adjust inflation on specific fees paid to community development disabled service
       SB 305 Community Services Reimbursement Rate Commission - Termination Date
        Extension and Modifications: This bill will extend the termination date for Community Service
        Reimbursement Rate Commission. This would require the Commission to assess changes in wages
        paid by specific providers and level of and changes in wages paid by providers and direct support
       HB 116 Mental Hygiene-Emergency Evaluation Petition – Licensed Clinical Marriage and
        Family Therapist: The bill would add licensed clinical marriage and family therapists to the
        professionals authorized to diagnose a mental disorder for purposes of seeking an emergency
        evaluation of an individual; authorizing licensed clinical marriage and family therapists to petition for
        an emergency evaluation and to sign and submit the emergency evaluation to peace officers, etc. The
        bill is sponsored by Delegates Hubbard, Benson, Montgomery, Nathan-Pulliam, Oaks, Riley, Tarrant,
        V. Turner, and Weldon and assigned to Health and Government Operations.

News and Noteworthy
    Maryland has over 10,000 veterans of the Iraq and Afghanistan conflicts, with at least 5,000 more
        projected to return by the end of the year. It is estimated that roughly half of these veterans and
        their families will require support to address behavioral health problems, and the program established
        by the Administration’s bill (SB 210) will ensure they get the help they need. (Governor O’Malley’s
        website/legislative priorities/initiatives for 2008)
    Maryland has 16% fewer physicians in clinical practice than the national per capita average, a
        shortage that could become severe by 2015, according to a report released 1/7/08 by MedChi,
        Maryland’s medical society, and the Maryland Hospital Society, as reported in The Washington Post.
        According to the report, analysts interviewed administrators at 52 hospitals in the state and several
        medical residency program directors and primary and specialty care physicians. (Levine, Washington
        Post, 1/8/08).
    Through the Mental Health Transformation project, Maryland will be one of the first state’s to
        implement the Mental Health First Aid (MHFA) evidence based program. MHFA is a curriculum
        that teaches skills for providing initial assistance to people experiencing mental health problems such
        as depression, anxiety disorders, psychosis and substance abuse.

County Status Report

Budget Update
     On January 22, 2008, the Montgomery County Council unanimously approved a budget savings plan
        that will reduce spending by the County government and County agencies by $33.2 million over the
        remainder of FY 08, which ends on June 30. The reductions include $19.1 million in County
        Government operations. The action was taken to help the County address a $400.9 million operating
        budget shortfall projected by County Executive Isiah Leggett for FY 09. The County Executive and
        Montgomery County agencies proposed the following savings for the remainder of FY 08:
             o Montgomery County Government:              $23,635,350
             o Montgomery County Public Schools           $10,200,000
             o Montgomery College                         $ 1,972,000
             o Maryland-National Capital Park and

                          Planning Commission               $ 1,937,300

                 TOTAL                                    $37,744,650
       The savings proposed by the County Executive for County Government, but not approved by the
        Council totaled $4,502,200 and included the following in the Department of Health and Human
            o Reduce SNH-Supportive Housing Rental Assistance Program (SHRAP) and Partnership for
                 Permanent Housing (PPHl) subsidies: $265,000
            o Delay implementation of new FY 08 initiatives: $574,950
            o Reduce home care services: $30,000
            o Reduce treatment slots available to Avery Road Combined Care: $50,000
                 (Montgomery County Press Release, 1/22/08)

        On January 22, the treatment slots at Avery Road Combined Care, the SHRAP program and the
        Mobile Crisis Team third shift were returned to the budget by the Montgomery County Council.

National Status Report

Legislative Update
      At the end of 2007, the House and Senate easily passed (and President Bush subsequently signed) the
          Medicare, Medicaid and SCHIP Extension Act of 2007 to extend federal funding for the State Children's
          Health Insurance Program (SCHIP) through March 2009.
          Although this legislation provides just enough funding to maintain current SCHIP enrollment levels
          the bill does not include funds to extend the program to any of the more than nine million uninsured
          children in America, nor did it make any critical policy improvements to enroll the more than six
          million uninsured children who are currently eligible for Medicaid or SCHIP, but are not enrolled.
          (from the Children’s Defense Fund)
      HR 687 and SB 382 The Keeping Families Together Act: The bill would establish a State family
          support grant program to end the practice of parents giving legal custody of their seriously
          emotionally disturbed children to State agencies for the purposes of obtaining mental health services
          for those children. Referred to the Subcommittee on Health in February 2007. (From the Depression
          and Bipolar Support Alliance – DBSA)
      HR 171 The Student Support Act: The bill would direct the Secretary of Education to make grants
          to states for assistance in hiring additional school-based mental health and student service providers.
          Referred to the House Committee on Education and Labor. (From the Depression and Bipolar
          Support Alliance – DBSA)
      HR 20 and SB 1375 The Melanie Stokes Postpartum Depression Act: The bill will help to
          ensure that new mothers and their families are educated about postpartum depression, screened for
          symptoms, and provided with essential services, and to increase research at the National Institutes of
          Health on postpartum depression. Received in the Senate and read twice and referred to the
          Committee on Health, Education, Labor, and Pensions. (From the Depression and Bipolar Support
          Alliance – DBSA)

Budget Update
     The President’s 2008 budget includes a 29 percent cut in mental health programs targeted to meet
        the special emotional needs of children and adults and holds at 2006 funding levels the Children’s
        Mental Health Services Program and the Community Mental Health Services Block grant, which
        support comprehensive community-based systems of care for children with serious emotional
        disturbances. (Source: Children’s Defense Fund)

State Status Report

Legislative Update
      SB 78 Task Force to Study System Variables that Impact Student Achievement in
          Underperforming Public Schools: The bill establishes the membership, purposes, and staffing of
          the Task Force. The Bill is in the Senate, First Reading Education, Health and Environmental Affairs
          Committee. A hearing was held on January 23 at 2:30 p.m.
      HB 285 and SB 96 Education – Truancy Rates – Positive Behavioral Interventions and
          Support Programs and Behavior Modification Programs: The bill requires a county board of
          education to require a school that has a truancy rate that exceeds specified standards to implement a
          positive behavioral interventions and support program or an alternative research based positive and
          effectible behavior modification program in collaboration with the State Department of Education.
          A hearing on the bill will be held on February 5 at 1:00 p.m.

Budget Update
        Below is a preliminary analysis of the FY 09 state budget, provided by Action for Children and the
        Children’s Action Network

Child Welfare
     $1.2 million to fund 24-hour Mobile Crisis Teams, in partnership with the Department of Health and
        Mental Hygiene, to stabilize family foster care placements and improve mental health outcomes.
     $3.1 million to raise the amount of monthly grants to each family foster home by approximately $100
        per month. It is not clear what ―approximately‖ means or whether these increases will be uniform
     $3.2 million for the Baltimore City Health Suite and the Family Centered Practice Training, bringing
        total funding to $4.3 million and $639,360, respectively. It is not clear how much of the training
        funding is new or for whether it is being used for effective implementation of Family Team Decision
     Unknown amount of money for the Maryland Children’s Electronic Social Services Information
        Exchange (MD CHESSIE); an additional $11.3 million is provided for CHESSIE and other
        technology projects; it is unclear how much is for CHESSIE.
     The Secretary has proposed paying $500 bonuses for foster parents who find other foster parents. It
        is not clear whether this is funded in the budget.
     The Secretary has said the Department is restoring childcare for children in foster care. It is not clear
        whether this is funded in the budget.
     The Secretary has proposed expanding respite care for foster parents, but it is not clear whether this
        is funded in the budget.

    There is no additional money to expand Positive Behavioral Interventions and Supports (PBIS)

     The School-Based Health Center is in the Governor’s budget at level funding from last year

County Status Report

Budget Update
The St. Mark’s Coalition for Mental Health, a broad-based coalition of Montgomery County mental health
advocates and providers who work to improve services and promote recovery for all Maryland residents with
mental health needs, has identified the following priorities for children’s mental health programming in the
County budget. These priorities were communicated in a letter to County Executive Isaiah Leggett:
     Increase funding for mental health clinics in the county by $322,600 for FY 09. The increase would
        eliminate the annual shortfall that results in no funding for the last two months of the fiscal year;
        catch up COLAs; and increase in specialized services, including child and family treatment and child
     Expansion for the Linkages to Learning program’s infrastructure so that it can adequately support
        the rapidly-growing service delivery system in 28 school-based sites.
     Expand clinical and case management capacity for the early childhood arena through mental health
        consultation and home visiting services for formal child care providers and families.
     Protect and build the system of care for children with intensive needs. Urge the maintenance of State
        and local funds for wraparound community-based services for children with developmental and
        severe emotional disabilities, including respite, mentoring, and non-traditional services to meet the
        unique needs of each child and family.

State Report

Legislative Update
      The Governor is introducing legislation to assist in reforming our juvenile justice system. The
          Governor will want to allow critical information-sharing between the Department of Juvenile
          Services and Office of Parole and Probation. The communication between the agencies will provide
          more accurate risk assessments and treatment plans, decrease recidivism, and increase monitoring.
          (State of Maryland website 1/2008)
      The Maryland Disability Law Center (MDLC) is introducing legislation to increase use of evidence-
          based practices by the Department of Juvenile Services (DJS). The legislation would create a 5 year
          pilot program to divert youth from DJS facilities which mandates the use of evidence-based
      SB 1 Maryland Legislative Youth Advisory Council: First reading was January 17 and no action
          was taken. This bill will establish a process of implementation for providing appointment,
          membership, duties to Council, and co-chairs for the Council. The Council will be required to work
          with the State Board of Education including youth in a high school, GED program, or home
      HB 90 and SB 57 Child Welfare – Permanency Planning and Interstate Placement of Foster
          Children: The bill changes the factors a juvenile court is required to consider in making findings in
          permanency planning and review hearings; increases, from 7 to 10, the number of days’ notice a local
          department of social services is required to give to specified persons before permanency planning
          and review hearings; requiring the court to consult with the child on the record in an age appropriate
          manner at least every 12 months at a permanency planning or review hearing. A hearing was held on
          January 17.

News and Noteworthy

       Last fall, there was a Request for Proposal (RFP) to create an interagency planning process to address
        the needs of youth in the DJS system. The Mental Health Association of Maryland has been selected
        to serve on the Council.

County Status Report

News and Noteworthy
    The County Executive’s office has established a Positive Youth Development Initiative targeted
        at three geographic areas: Germantown, Wheaton, and Long Branch in Silver Spring. The
        Initiative is called the Community Based Collaborative and each location is holding regular
        meetings to identify and mobilize resources to create supportive opportunities for youth. The
        Community Based Collaborative forums discuss issues, challenges, and idea to improve the
        quality of life for youth.

National Status Report

Legislation Update
      Veteran’s Supportive Housing Appropriations: In FY08 appropriations, there were new provisions
          for housing and homelessness for veterans. New vouchers for homeless veterans are due to increase
          to 8,000-10,000 from 1,800. The process for distribution of vouchers hasn’t been decided, but the
          Public Housing Agencies and VA medical centers will work in collaboration. (National Alliance to
          End Homelessness 1/2008)
      HR 3257 HOPE VI Improvement and Reauthorization Act: This bill has required
          redevelopment plans to address the needs of hard-to-place families including the elderly, displaced
          families needing special services, veterans, and other groups. The bill would require one-to-one
          replacement of all units, retroactive January 1, 2005 and allowing public housing agencies to seek
          smaller replacements under certain circumstances. This bill was introduced by Representative’s
          Maxine Waters (D-CA), Barney Frank (D-MA), Christopher Shays (R-CT), Mel Watt (D-NC), and
          Stephen Cohen (D-TN).

Budget Update
     On Tuesday, February 5, 2008 the National Alliance to End Homelessness is hosting its Annual
        Federal Budget Briefing. The release of the budget reflects the Administration’s priorities for the
        upcoming fiscal year. (National Alliance to End Homelessness 1/2008)

News and Noteworthy
    The U.S. Department of Health and Human Services Administration is accepting applications
        for the Basic Center Program. The Basic Center Program provides youth with emergency
        shelter, food, and clothing for up to15 days. (National Alliance to End Homelessness 1/2008)

County Status Report

Budget Update
     The County Executive’s FY09 Budget has proposed to maintain the current level of funding for
     Last year Montgomery County adopted the Housing First Initiative and began directing funding for
        housing through this model. Housing First is an approach to ending homelessness that centers on
        providing homeless people with housing quickly and then providing services as needed. What

        differentiates a Housing First approach from traditional emergency shelter or transitional shelter
        approaches is that it is ―housing based,‖ with an immediate and primary focus on helping individuals
        and families quickly access and sustain permanent housing. This approach has the benefit of being
        consistent with what most people experiencing homelessness want and seek help to achieve.
        Housing First programs share critical elements:
             o There is a focus on helping individuals and families access and sustain permanent housing
                 stability as quickly as possible, and the housing is not time-limited;
             o A variety of services are delivered primarily following a housing placement to promote
                 housing stability and individual well-being;
             o Such services are time-limited or long-term depending upon individual need; and
             o Housing is not contingent on compliance with services—instead, participants must comply
                 with a standard lease agreement and are provided with the services and supports that are
                 necessary to help them do so successfully.

News and Noteworthy
    The County Executive’s FY08 Budget approved the Montgomery County Coalition for the
        Homeless to provide day programming for the homeless men at the East Guide Drive Campus in
        collaboration with the Department of Health and Human Services (DHHS). The following services
        were to be provided to unemployed clients: mental health services, planned health care, substance
        abuse services, and employment services. The Montgomery County Council is considering cutting
        these services for the already approved FY08 Budget.

       Legislative information compiled by Colleen Fee, Jennifer Gauthier, Pat Crist and Jim Vurpillot

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