Funding and Characteristics of 

State Mental Health Agencies, 2007

US DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov
Funding and 

Characteristics

of State

Mental Health 

Agencies, 2007

One Choke Cherry Road

Rockville, Maryland 20857
Funding and Characteristics of State Mental Health Agencies, 2007 iii

Acknowledgments

This report was produced by the U.S. Department of Health and Human Services (HHS), 

Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental 

Health Services (CMHS). The report was prepared by the National Association of State Mental 

Health Program Directors (NASMHPD) under Contract No. 280-03-3205. The authors of the 

report are: Theodore C. Lutterman, Bernadette E. Phelan, Ph.D., Azeb Berhane, Robert Shaw, 

and Verda Rana. Joanne Atay, M.A., Division of State and Community Systems Development, 

served as the government project officer.

Disclaimer

The views, opinions, and content of this publication are those of the authors and do not 

necessarily reflect the views or policies of SAMHSA or HHS.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied 

without permission from SAMHSA. Citation of the source is appreciated. However, this 

publication may not be reproduced or distributed for a fee without the specific, written 

authorization of the Office of Communications, SAMHSA.

Electronic Access and Copies of Publication

This publication may be downloaded or ordered at www.samhsa.gov/shin. Or, please call 

SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) (English and 

Español).

Recommended Citation

Lutterman, T., Berhane, A., Phelan, B., Shaw, R., & Rana, V. (2009). Funding and 

characteristics of state mental health agencies, 2007. HHS Pub. No. (SMA) 09-4424. 

Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health 

Services Administration.

Originating Office

Survey, Analysis and Financing Branch, Division of State and Community Systems 

Development, Center for Mental Health Services, Substance Abuse and Mental Health Services 

Administration, One Choke Cherry Road, Rockville, MD 20857.

HHS Pub. No. (SMA) 09-4424.

Printed 2009
Funding and Characteristics of State Mental Health Agencies, 2007 v

Contents

Acknowledgments..................................................... iii

Executive Summary ................................................... 1

Overview ....................................................... 7

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Study Approach and Limitations .................................... 11

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Organization and Structure of SMHAs................................ 15

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 SMHA Mental Health Responsibilities..........................19

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SMHAs ................................................... 23

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1.

1.1 Impacts on SMHAs’ Areas of Focus

1.2 Outline of This Report

II.

2.1 Study Approach

2.2 SMHA Profiling System

2.3 SMHA-Controlled Revenue and Expenditure Study

2.4 The Uniform Reporting System

2.5 Limitations

III.

3.1. Location of SMHAs Within State Government

3.1.1 Mental Health Boards/Commissions

3.2 Other Disability Service Responsibilities of SMHAs 

3.2.1 Substance Abuse Services Colocated With Mental Health 

Services

3.3 Reorganization of SMHAs

3.4

3.4.1 Children/Adolescent Mental Health Services

3.4.2 State Psychiatric Hospitals

3.4.3 Forensic Mental Health Services

3.4.4 Alzheimer’s Disease and Organic Brain Syndrome

3.4.5 Traumatic Brain Injury Services

3.5 Eligibility for SMHA Mental Health Services

3.5.1 Adult Mental Health Eligibility

3.5.2 Child and Adolescent Eligibility

3.6 Number of Mental Health Organizations Operated and/or Funded by 

3.6.1 SMHA Relationship to Local Providers

3.6.2 Privatization of SMHA-Operated Programs
vi Funding and Characteristics of State Mental Health Agencies, 2007

 . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Characteristics of Persons Served by SMHAs, FY 2007 ................... 25

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SMHAs’ Responsibilities for Community Mental Health Services ........... 33

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3.6.3 SMHA Class Action Lawsuits

IV.

4.1 Persons Served by Age and Gender 

4.1.1 Children and Adolescents

4.1.2 Adults

4.1.3 Older Adults

4.2 Persons Served by Race and Gender 

4.2.1 Children and Adolescents

4.2.2 Adults

4.2.3 Older Adults

4.3 Adults (SMI) and Children (SED) Served by SMHAs

4.3.1 Children (SED)

4.3.2 Adults (SMI)

4.3.3 Older Adults (SMI)

4.4 Living Situation of Mental Health Consumers Served

4.4.1 Children 

4.4.2 Adults

4.4.3 Employment Status

4.4.4 Employment Status by Diagnosis

4.5 Adults and Children With Co-Occurring Mental Health/Substance 

Abuse Disorders

4.5.1 Persons Served in Community and State Hospitals

4.6 Persons Served Through Medicaid and Other Funding Sources

V.

5.1 Role of County/City Government

5.2 Community Mental Health Providers

5.2.1 Community Providers Given Control Over Utilization or 

Budgets of State Psychiatric Hospitals

5.2.2 Community Providers Perform Gatekeeping Entry Into 

State Psychiatric Hospitals

5.3 Types of Community Mental Health Services Offered

5.4 Consumer-Operated Services

5.4.1 Types of Consumer-Operated Services

5.4.2 States Reimbursing Peer Specialists for Providing Mental 

Health Services Through Medicaid
Funding and Characteristics of State Mental Health Agencies, 2007 vii

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

............................... 37

 ........................... 37

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Covering Mental Health Services......................... 39

SMHA Psychiatric Inpatient Systems, Acute Care Issues, and Forensic Services. 41

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 ................................ 49

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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

New Freedom Commission Activities................................. 55

 

 ........................................... 55

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 ......... 57

..... 57

Primary Care Providers ................................ 57

 .......................... 58

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

5.4.3 Office of Consumer Affairs

5.4.4 Managed Care Practices 

5.4.5 SMHA Use of Managed Care

5.4.6 Services Provided Under Managed Care Plans

5.4.7 Medicaid Options Adopted by the State Medicaid Plan for 

VI.

6.1 State Psychiatric Hospitals

6.2 State Psychiatric Hospital Reorganization

6.3 Closing State Psychiatric Hospitals

6.3.1 Construction of State Psychiatric Hospitals 

6.3.2 How SMHAs Use State Psychiatric Hospitals

6.3.3 Use of Non-SMHA General Hospitals and Other Local 

Hospitals

6.4 Psychiatric Acute Care Shortages

6.5 Forensic Mental Health Services

6.5.1 Organization of State Forensic Mental Health Services

6.5.2 Not Guilty by Reason of Insanity and Guilty but Mentally 

Ill Statutes

6.5.3 Scope of Forensic Mental Health Services

6.5.4 Sex Offenders

6.5.5 Provision of Mental Health Services to Persons in Prison 

or Jails

VII.

7.1 Goal 1: Americans Understand That Mental Health Is Essential 

to Overall Health

7.1.1 Public Information Initiatives

7.1.2 Stigma

7.1.3 Suicide Prevention

7.2 Goal 2: Mental Health Care Is Consumer- and Family-Driven

7.2.1 Insurance Coverage and Parity for Mental Health Services

7.2.2 Recognition and Treatment of Persons With Mental Illnesses by 

7.2.3 Individualized Treatment Plans

7.2.4 Recovery Orientation 
viii Funding and Characteristics of State Mental Health Agencies, 2007

7.2.5 Consumer Involvement in Mental Health Systems . . . . . . . . . . . . 58

7.2.6 Psychiatric Advanced Directives . . . . . . . . . . . . . . . . . . . . . . . . . . 58

7.2.7 Types of Advanced Directives Supported . . . . . . . . . . . . . . . . . . . 59

7.2.8 Comprehensive Mental Health Plans . . . . . . . . . . . . . . . . . . . . . . 59

7.2.9 Fragmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

7.2.10 Child Custody Relinquishment . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

7.2.11 Services to Veterans and Military Members . . . . . . . . . . . . . . . . . 60

7.2.12 Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

7.2.13 Criminal Justice and Mental Illnesses . . . . . . . . . . . . . . . . . . . . . . 61

7.2.14 Mental Health Courts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

7.2.15 Prebooking Diversion Programs for Adults . . . . . . . . . . . . . . . . . 63

7.2.16 Postbooking, Preadjudication Diversion Programs for 

Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

7.2.17 Youth Diversion Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

7.2.18 Reentry Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

7.3 Goal 3: Disparities in Mental Health Services Are Eliminated . . . . . . . . . . 63

7.3.1 Cultural Competence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

7.3.2 Workforce Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

7.3.3 Workforce Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

7.3.4 Prescription Privileges and the Use of Licensed Health Care 

Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

7.3.5 Staffing in State Psychiatric Hospitals . . . . . . . . . . . . . . . . . . . . . . 65

7.3.6 Rural/Frontier Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

7.4 Goal 4: Early Mental Health Screening, Assessment, and Referral to 

Services Are Common Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

7.4.1 Screening for Mental Health Problems . . . . . . . . . . . . . . . . . . . . . 66

7.4.2 Older Adult Mental Health Services . . . . . . . . . . . . . . . . . . . . . . . 67

7.5 Goal 5: Excellent Mental Health Care Is Delivered and Research Is 

Accelerated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

7.5.1 Moving Research and Evaluations Into Practice . . . . . . . . . . . . . . 68

7.5.2 Research and Evaluations by SMHAs . . . . . . . . . . . . . . . . . . . . . . 68

7.5.3 Types of SMHA-Conducted Research/Evaluation . . . . . . . . . . . . 69

7.5.4 Evidence-Based Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

7.5.5 Assertive Community Treatment (ACT) . . . . . . . . . . . . . . . . . . . . 71

7.5.6 Supported Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

7.5.7 Medication Algorithms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Funding and Characteristics of State Mental Health Agencies, 2007 ix

7.5.8 Family Psychoeducation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

7.5.9 Integrated Dual Diagnosis Treatment (Mental Illness 

and Substance Abuse) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

7.5.10 Illness Self-Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

7.5.11 Supported Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

7.5.12 Consumer-Operated Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

7.5.13 Multisystemic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

7.5.14 Therapeutic Foster Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

7.5.15 Functional Family Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

7.5.16 School-Based Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

7.5.17 Older Adult Evidence-Based Practices . . . . . . . . . . . . . . . . . . . . . . 76

7.5.18 Training for Evidence-Based Practices . . . . . . . . . . . . . . . . . . . . . . 77

7.5.19 Barriers to Implementing Evidence-Based Practices . . . . . . . . . . . . 78

7.5.20 SMHA Initiatives to Support the Adoption of EvidenceBased Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

7.5.21 Emerging Evidence-Based Practices . . . . . . . . . . . . . . . . . . . . . . . . 78

7.5.22 Clinical Practice Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

7.6 Goal 6: Technology Is Used to Access Mental Health Care and 

 Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

7.6.1 Telemedicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

7.6.2 Electronic Health Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

7.6.3 Implementation of EHR Components . . . . . . . . . . . . . . . . . . . . . . 83

7.6.4 Sharing EHR Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

7.6.5 Reported Benefits of Using EHRs . . . . . . . . . . . . . . . . . . . . . . . . . 84

7.6.6 Electronic Pharmacy/Medication Ordering System . . . . . . . . . . . . 84

7.6.7 Medication Administration Recording . . . . . . . . . . . . . . . . . . . . . 84

7.6.8 Electronic Personal Health Records . . . . . . . . . . . . . . . . . . . . . . . 84

VIII. SMHA Financing of Mental Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

8.1 Mental Health Expenditures Controlled by State Mental Health 

 Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

8.2 Change in SMHA-Controlled Expenditures Over Time . . . . . . . . . . . . . . . 87

8.3 Shift From State Psychiatric Hospital-Based Services to 

 Community-Based Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

8.3.1 Variations in SMHA Expenditures . . . . . . . . . . . . . . . . . . . . . . . . 90

8.4 SMHA-Controlled Expenditures by Type of Mental Health Service . . . . . 91
x Funding and Characteristics of State Mental Health Agencies, 2007

8.5 SMHA-Controlled Mental Health Spending and Total State Government 

Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

8.6 State Tax Dollars Remain the Major Source of Funding of SMHAs . . . . . 94

8.7 SMHA Revenue Trends Over Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

IX. The SMHA and its Relationship With Other State Government Agencies . . . . 111

9.1 Analysis of Medicaid-Paid Claims Files . . . . . . . . . . . . . . . . . . . . . . . . . . 111

9.2 Linking SMHA Data With Other State Agency Data . . . . . . . . . . . . . . . . 112

9.3 Participation in Special Projects That Strengthen Collaborative 

Relationships With Other State Agencies . . . . . . . . . . . . . . . . . . . . . . . . . 112

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

List of Tables

Table 1: SMHA Organization, Structure, and Relationship to Substance Abuse and 

Mental Retardation/Developmental Disabilities Agencies . . . . . . . . . . . . . . . . . 16

Table 2: SMHA Mental Health–Related Responsibilities . . . . . . . . . . . . . . . . . . . . . 21

Table 3: Eligibility Criteria to Receive Mental Health Services From SMHAOperated/SMHA-Funded Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Table 4: Number of Mental Health Organizations Operated or Funded by SMHAs, 

2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Table 5: Examples of SMHA Initiatives to Integrate Private and Public Mental 

Health Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Table 6: Primary Methods Used by SMHAs to Fund Community Mental Health 

Services, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Table 7: Methods of Gatekeeping That Control Entry to and Discharge From State 

Psychiatric Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Table 8: Community-Based Services Targeted Toward Specific Population Groups . 36

Table 9: Types of Consumer-Operated Services Funded by the SMHA . . . . . . . . . . . 37

Table 10: Services Provided by Self-Identified Consumers . . . . . . . . . . . . . . . . . . . . . 38

Table 11: Services Provided via Managed Care Plans . . . . . . . . . . . . . . . . . . . . . . . . 39

Table 12: Number of Resident Patients, Total Admissions, Net Releases, and 

Deaths: State and County Psychiatric Hospitals, 1950–2005 . . . . . . . . . . . . . . . 43

Table 13: State Psychiatric Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Table 14: Number of States Using State Psychiatric Hospitals by Age and Service . . 46
Funding and Characteristics of State Mental Health Agencies, 2007 xi

Table 15: Number of 24-Hour Hospital and Treatment Beds . . . . . . . . . . . . . . . . . . 47

Table 16: 24-Hour Hospital and Residential Treatment Beds per 100,000 

Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Table 17: Forensic Status of State Psychiatric Hospital Residents . . . . . . . . . . . . . . . 52

Table 18: Responsibilities for Sex Offender Services . . . . . . . . . . . . . . . . . . . . . . . . . 52

Table 19: How SMHAs Promote Consumer Choice (Number of SMHAs 

Reporting) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Table 20: SMHAs Has initiative Under Way to Work With Other State Government 

Agencies to Coordinate, Reduce, or Eliminate Barriers Between Delivery 

Systems and Funding Streams (Number of SMHAs Reporting) . . . . . . . . . . . . . 59

Table 21: Barriers That Impede the SMHAs’ Ability to Address Consumer Housing 

Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Table 22: SMHA Cultural Competence Activities Needs . . . . . . . . . . . . . . . . . . . . . . 64

Table 23: Number of SMHAs Implementing/Planning to Implement Adult 

EBPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Table 24: Number of SMHAs Implementing/Planning to Implement Child/

Adolescent EBPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Table 25: Funding Sources for ACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Table 26: Type of Information the SMHA Makes Available via the Internet . . . . . . . 81

Table 27: EHR Modules Implemented in State Psychiatric Hospitals and 

Community Mental Health Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Table 28: Sharing EHR Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Table 29: Average Annual Change in State Government Expenditures: FY 

1997 to FY 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Table 30: SMHA Mental Health Actual Dollar and per Capita Expenditures by 

State, FY 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Table 31: SMHA Mental Health Actual Dollar and per Capita Expenditures by 

State, FY 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Table 32: SMHA Mental Health per Capita Expenditures for State Mental 

Hospitals, Community-Based Programs, and State Mental Health Support 

Activities by Type of Service Setting and by State, FY 2005 (in Millions) . . . . 101

Table 33: SMHA-Controlled Mental Health Expenditures by Type of Program, FY 

2005 (in Millions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Table 34: SMHA Mental Health-Controlled per Capita Expenditures for State 

Mental Hospital Inpatient Services, Community Services Research, 

Training, and Administration: FY 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
xii Funding and Characteristics of State Mental Health Agencies, 2007

Table 35: SMHA Mental Health-Controlled Expenditures per Inpatient 

Day, All Civil (Voluntary and Involuntary) Patients in State Psychiatric 

Hospitals by Age and State, FY 2005 (in Millions) . . . . . . . . . . . . . . . . . . . . . 104

Table 36: SMHA Mental Health-Controlled Expenditures per Inpatient 

Day, All Forensic Patients in State Psychiatric Hospitals Receiving 

Mental Health Services, by State, FY 2005 (in Millions) . . . . . . . . . . . . . . . . . 105

Table 37: SMHA-Controlled Mental Health Revenues, by Revenue Source 

and by State, FY 2005 (in Millions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Table 38: SMHA-Controlled Mental Health Revenues to Community 

Programs, by Revenue Source and by State, FY 2005 (in Millions) . . . . . . . . . 107

Table 39: SMHA-Controlled Mental Health Medicaid Revenues as a 

Percentage of Total State Medicaid Spending, by State, FY 2005 . . . . . . . . . . 108

Table 40: FY 2001 to FY 2005 SMHA-Controlled Mental Health Expenditures 

(in Millions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Table 41: FY 2001 to FY 2005 Percent Change in SMHA-Controlled Mental 

Health Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

Table 42: Other State Agencies SMHAs Link Data With . . . . . . . . . . . . . . . . . . . . 113

List of Figures

Figure 1: SMHA Responsibilities for Substance Abuse and MR/DD Services . . . . . 17

Figure 2: Number of States With Mental Health and Substance Abuse 

Colocated in One Agency: 1981 to 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Figure 3: Percentage of Consumers Served by Age . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Figure 4: Utilization Rates of Persons Served by Age and Gender (Rate per 1,000) . 26

Figure 5: Utilization Rates of Children (0–17) by Race and Gender (Rate per 1,000) 27

Figure 6: Utilization Rates of Adults (18–64) by Race and Gender (Rate per 1,000) 28

Figure 7: Utilization Rates of Older Adults (65 and Over) by Race and Gender 

(Rate per 1,000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Figure 8: Employment Status of Adult Mental Health Consumers, 2007 . . . . . . . . . 30

Figure 9: Persons Served in Community, State Hospitals, and Other Inpatient 

Beds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Figure 10: Persons Served by Medicaid and Other Funding Sources . . . . . . . . . . . . . 31

Figure 11: Persons Served by Medicaid and Other Funding Sources by Race . . . . . . 32
Funding and Characteristics of State Mental Health Agencies, 2007 xiii

Figure 12: Primary Methods SMHAs Use to Fund Community Mental Health 

Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Figure 13: Medicaid-Managed Care Waivers Used for Mental Health . . . . . . . . . . . 38

Figure 14: Number of State Psychiatric Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Figure 15: State Psychiatric Hospital Residents per 100,000 Population . . . . . . . . . . 42

Figure 16: State Psychiatric Hospital Reorganization Activities, 2007 . . . . . . . . . . . 44

Figure 17: SMHAs Experiencing a Shortage of Psychiatric Inpatient Beds, 2007 . . . 48

Figure 18: SMHA-Controlled Forensic and Sex Offender Mental Health 

Expenditures, FY 1983– FY 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Figure 19: SMHA Responsibility for Forensic Mental Health Services, 2007 . . . . . . 50

Figure 20: SMHA Has Stigma and Discrimination Initiatives . . . . . . . . . . . . . . . . . 56

Figure 21: States With Mental Health Court and/or Jail Diversion Programs . . . . . . 62

Figure 22: SMHA Shortages of Mental Health Staff by Discipline, 2007 . . . . . . . . . 65

Figure 23: SMHA Early Detection of Mental Health Problem Initiatives . . . . . . . . . 67

Figure 24: Organizational Location of Research and Evaluation . . . . . . . . . . . . . . . 69

Figure 25: Number of EBPs Being Implemented by States . . . . . . . . . . . . . . . . . . . . . 70

Figure 26: SMHA Uses or Promotes Telemedicine for Mental Health . . . . . . . . . . . . 82

Figure 27: Implementation of EHRs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Figure 28: EHR Status in State Psychiatric Hospitals . . . . . . . . . . . . . . . . . . . . . . . . 83

Figure 29: Total FY 2005 SMHA-Controlled per Capital Mental Health 

Expenditures (in Billions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Figure 30: Trend in SMHA-Controlled Mental Health Spending, FY 1981 to 

FY 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Figure 31: Average Annual Change in SMHA-Controlled Mental Health 

Expenditures, 1981 to 2005, by Decade and Type of Program . . . . . . . . . . . . . 89

Figure 32: SMHA Expenditures for State Psychiatric Hospital Inpatient and 

Community-Based Services as a Percent of Total Expenditures: FY 1981 to FY 

2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Figure 33: FY 2005 SMHA-Controlled Per Capita Expenditures for Mental Health 

Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Figure 34: SMHA-Controlled Mental Health Expenditures by Type of Service: FY 

1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Figure 35: SMHA-Controlled Mental Health Expenditures by Type of Service: FY 

2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Figure 36: SMHA-Controlled Expenditures by Type of Mental Health Service: FY 

1981 to FY 2005 (Expenditures in Billions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
xiv Funding and Characteristics of State Mental Health Agencies, 2007

Figure 37: Total SMHA-Controlled Mental Health Expenditures as a Percent of 

 Total State Government Expenditures: FY 1981 to FY 2005 . . . . . . . . . . . . . . . 94

Figure 38: SMHA-Controlled Expenditures as a Percent of Total State Government 

Expenditures: FY 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Figure 39: SMHA-Controlled Revenues for Mental Health, FY 2005 . . . . . . . . . . . . 96

Figure 40: SMHA-Controlled Revenues for Mental Health Services: FY 1981 

 to FY 2005 (in Billions)............................................ 96

Figure 41: Percent of SMHA-Controlled Community Mental Health Revenues by 

Major Sources: FY 1981 to FY 2005 ................................. 98

Figure 42: Percent Increase in SMHA-Controlled Revenues From Major Funding 

Sources: FY 1981 to FY 2005 ....................................... 98
Funding and Characteristics of State Mental Health Agencies, 2007 1

Executive Summary

State Mental Health Agencies (SMHAs) are the state government 

agencies responsible for assuring the provision of mental health 

services to persons with mental illnesses and emotional disturbances. 

SMHAs annually administer nearly $30 billion to provide mental health 

services to over 6 million individuals. SMHAs vary widely regarding how 

they are organized within state government, the specific array of disability 

services they deliver, the way they organize and deliver mental health 

services, and their eligibility and funding requirements. This report provides 

a comprehensive review of the various ways SMHAs are organized and 

structured, their major policy initiatives to better meet the mental health 

needs of the residents of their state, the mental health services they provide 

or fund, and how they finance these services.

SMHA Organizational Location in State

Government 

Most SMHAs are now organized as a 

division or agency within a larger state 

government department. Most SMHAs (29) 

are now a division within a department of 

human services that is also responsible for 

Medicaid, social services, children’s services, 

and older adult services. Fewer SMHAs (13) 

are organized as Cabinet-level departments 

that report directly to the Governor’s office 

or to a mental health oversight board.

Non-Mental Health Disability 

Responsibilities of SMHAs

Beyond mental health services, most 

SMHAs are also responsible for other 

disability services. In the most common 

organizational arrangement (28 states), the 

SMHA is responsible for both mental health 

and substance abuse services. A frequent 

rationale for this organizational structure is 

that persons with serious mental illnesses 

(SMI) often have co-occurring substance 

abuse problems. Colocating the service 

responsibilities facilitates better coordination 

of co-occurring service needs. However, a 

substantial number of SMHAs—particularly 

agencies in the larger states (California, New 

York, Illinois, and Ohio)—are responsible 

only for provision of mental health services.

SMHA Eligibility Criteria 

Although all SMHAs provide mental 

health services to adults with SMI and 

usually also serve children with serious 

emotional disturbances (SED), states differ 

in how they operationally define SMI and 

SED. States also differ regarding eligibility 

criteria for determining who qualifies for 

SMHA services. Some states (19) restrict the 

use of state dollars to serve only persons 

who meet the state’s definition of SMI. 

Other states provide or fund services to 
adults and children who have mental health 

needs but do not meet the state definition of 

SMI. 

Types of Mental Health Services 

Provided by SMHAs

SMHAs vary widely in the responsibilities 

they assume for different types of mental 

disorders and service populations. While all 

SMHAs serve adults with mental health 

issues, there are three states where all 

children’s mental health services are 

provided by a separate state agency. This 

agency is usually integrated into a 

department of children and their families 

that provides mental health, child substance 

abuse, developmental disability, child 

welfare, and juvenile justice services. 

In most states (47), the SMHA is 

responsible for providing forensic mental 

health services to persons sent by the courts 

because of their criminal justice system 

involvement. In 20 states, services for brain 

impairment (traumatic brain injury) are part 

of SMHA responsibilities or a responsibility 

the SMHA shares with other state agencies. 

Alzheimer’s disease and dementia are 

responsibilities the SMHA shares with other 

state agencies in 17 states.

Persons Served by SMHAs

In 2007, SMHAs provided mental health 

services to over 6 million persons, just over 

2 percent of the population of the United 

States. Over 96 percent of the persons who 

received SMHA services received 

community-based services (usually 

outpatient or other less-than-24-hour 

services provided in their own communities), 

while 3 percent received services in state 

psychiatric hospitals, and 7 percent received 

inpatient services from general hospitals or 

private psychiatric hospitals. Consumers 

may be served in more than one setting 

during the year.

Persons with mental illness served by 

SMHAs were mostly White (62 percent) or 

African American (20 percent). However, 

the utilization rates∗ for most minorities 

(African Americans, Native Americans, and 

Hispanics) were higher than the rates*

 for 

Whites or Asian Americans. Equal numbers 

of males and females were served by 

SMHAs, although this differed slightly by 

age (more boys were served than girls among 

children, but slightly more females than 

males among adults).

Persons served by SMHAs tended to be 

unemployed (only 21 percent of adult 

SMHA consumers were employed) and 

poor—57 percent had Medicaid** that paid 

a portion of their mental health services. 

The majority of adults in the SMHA system 

(80 percent) lived in private residences, but 3 

percent were homeless or living in shelters, 

and 2 percent were living in jails or other 

correctional settings when their living 

situation was last assessed.

SMHA Provision of Community Mental 

Health Services

Every SMHA develops and implements a 

plan for a comprehensive mental health 

service system as a requirement to receive 

Federal Community Mental Health Services 

Block Grant funds. The community mental 

health systems in states provide a variety of 

ambulatory services such as individual 

outpatient counseling, group therapy, 

* Utilization rates refer to the number of persons 

of a particular age, gender, or race/ethnicity 

divided by that group’s population in a state.

** Medicaid is a state-Federal program that pays for 

health care for low-income individuals and those 

with disabilities.

2 Funding and Characteristics of State Mental Health Agencies, 2007
medications management, day treatment, 

case management, peer support services, 

vocational and educational supports, 

housing supports, and training and skill 

development to foster recovery from mental 

illness. Increasingly, SMHAs are 

implementing evidence-based practices 

(EBPs) designed to ensure consumers receive 

services that mental health research has 

proven to be effective.

All SMHAs reported they are 

implementing and supporting at least one of 

the EBPs identified by the Center for Mental 

Health Services (CMHS), Substance Abuse 

and Mental Health Services Administration 

(SAMHSA). The most frequently 

implemented EBPs are supported 

employment, assertive community treatment 

(ACT), and integrated treatment for 

co-occurring mental illness and substance 

abuse.

SMHAs vary in how they organize and 

finance the delivery of these communitybased mental health services. Although most 

SMHAs contract with private not-for-profit 

community mental health centers and other 

community providers, many of the larger 

states work through county or city 

government mental health agencies. Several 

smaller population states provide SMHA 

services using state employees working in 

mental health centers operated by the 

SMHA.

SMHA Provision of Inpatient 

Psychiatric Services 

Although all SMHAs operate psychiatric 

inpatient beds designed to provide safe and 

effective services to individuals with the 

most severe psychiatric illnesses, states vary 

widely regarding how many psychiatric beds 

they have and the patient populations the 

inpatient services are designed to serve. 

Increasingly, state psychiatric hospital beds 

are being used for short-term “acute” clients 

and to serve forensic clients.

States have significantly downsized their 

state psychiatric hospitals over time (with 

the number of state psychiatric beds having 

declined by 90 percent from 1950 to 2005). 

Data on the number of psychiatric inpatient 

beds in America over the last 35 years show 

that not only have the number of state 

psychiatric hospital beds declined, but the 

numbers of psychiatric inpatient beds in 

private psychiatric hospitals, in general 

hospitals, and in the Department of Veterans 

Affairs have also declined. 

The impact of closing all these psychiatric 

inpatient beds is that 39 of 49 reporting 

states (80 percent) are now experiencing a 

shortage of psychiatric beds. SMHAs are 

responding to these shortages with a variety 

of strategies including developing 

community-based crisis services and 

increased use of EBPs.

SMHA Policy Initiatives

This decade, two major Federal 

government reports have examined the 

mental health systems in America and 

proposed a series of goals and actions to 

improve mental health services. The 

President’s New Freedom Commission on 

Mental Health (PNFC) (US DHHS, 2003) 

formulated six major goals to transform 

mental health services. The Institute of 

Medicine (IOM) reviewed the mental health 

and substance use services through the lens 

of their “Crossing the Quality Chasm” 

framework and developed an action agenda 

to improve services (IOM, 2006).

Funding and Characteristics of State Mental Health Agencies, 2007 3
4 Funding and Characteristics of State Mental Health Agencies, 2007

SMHAs have embraced these goals and 

objectives and are actively working to meet 

the goals established by the PNFC and the 

IOM:

■ Most SMHAs are now supporting 

initiatives to better inform the public 

about mental illness and reduce its stigma. 

Most SMHAs are also now working to 

promote suicide awareness and reduce the 

incidence of suicide in their state. These 

initiatives often link the SMHA with state 

and/or local health departments.

■ SMHAs are working with state and local 

health departments and other community 

health providers to recognize and meet the 

physical health needs of persons with 

mental illnesses. A CMHS-funded study 

by the National Association of State 

Mental Health Program Directors 

Research Institute, Inc. (NRI), 

(Lutterman, Ganju, Schacht, Shaw, 

Monihan, et al., 2003) found that persons 

with mental illness served in the SMHA 

system often die prematurely (up to 25 

years of lost life)—often from a variety of 

physical health conditions such as 

coronary artery disease, diabetes, obesity, 

and other treatable health conditions. 

SMHAs have embraced the concept of 

recovery from mental illness—that 

consumers can heal and live meaningful 

lives in a community of their own 

choosing. SMHAs have engaged in 

numerous initiatives to promote consumer 

choice of services and to ensure consumers 

have individualized treatment plans 

reflecting their needs and desires.

■ Most SMHAs have initiatives to assure 

that the mental health services they 

provide incorporate the cultural and 

linguistic background of mental health 

consumers. 

■ Most states reported initiatives to promote 

the early detection of mental illness. Most 

states (40) have early screening programs 

for children, and 19 states reported such 

early detection initiatives for adults. 

■ Most SMHAs reported working with 

academia to translate research results into 

practice. Every state reported 

implementing at least one EBP, and most 

states are supporting several different 

EBPs.

■ SMHAs are using technology to enable 

consumers and families to access mental 

health care and information. Nearly all 

(94 percent) of the reporting 50 states are 

either implementing or considering the 

adoption of an electronic health record 

(EHR) in their state psychiatric hospitals 

and/or community mental health system. 

Most SMHAs (90 percent or 44 states) are 

now engaged in activities to promote the 

use of telemedicine to provide mental 

health services.

Financing of SMHA Mental Health 

Services

In state fiscal year (FY) 2005, the 

SMHAs controlled and directed the 

expenditures of $30 billion to provide 

mental health services. Over 70 percent of 

SMHA expenditures were devoted to 

community-based services, with 27 percent 

devoted to state psychiatric hospital 

inpatient services. 

State government sources contributed 

$18.8 billion (63 percent of SMHA funding), 

with state general and special revenues 

making up $13.9 billion of SMHA funding. 
Funding and Characteristics of State Mental Health Agencies, 2007 5

Medicaid, a joint state-Federal health 

insurance program, was the second largest 

funder (42 percent) and paid $12.5 billion 

(Federal and state shares combined) for 

SMHA mental health services. Over the last 

25 years, Medicaid has been the fastest 

growing source of funds for the SMHA 

mental health system, growing at an average 

rate of 12 percent per year.

Other State Government Provision of 

Mental Health Services

Although the SMHA is legally responsible 

for planning, organizing, and providing 

mental health services to individuals with 

mental illnesses, it is not the only state entity 

that provides such services. Increasingly, 

other state government agencies, particularly 

Medicaid, and other state agencies such as 

the departments of corrections, vocational 

rehabilitation, child welfare, juvenile justice, 

and housing play critical roles in providing 

or financing the provision of mental health 

services. Each of these agencies has its own 

data collection and reporting systems that 

make counting the provision of mental 

health services provided by these systems 

exceedingly difficult. However, a pilot study 

funded by CMHS/SAMHSA and conducted 

by the NRI (Phelan, Lutterman, Berhane, 

Frank, Rivard, et al., in press) found that in 

several states, the total state government 

agency spending on mental health is over 

twice that of the amount identified by the 

SMHAs alone.

Funding and Characteristics of State Mental Health Agencies, 2007 7

I. Overview

This section presents an overview of State Mental Health Agencies 

(SMHAs) and briefly highlights some landmark reports that have 

impacted the SMHAs’ areas of focus. SMHAs are the single state 

government entity identified by the Governor of each state as the central 

authority related to mental health services. SMHAs provide the backbone of 

the organization, delivery, and financing of mental health services to adults 

with serious mental illiness (SMI) and children and adolescents with serious 

emotional disturbance (SED). In delivering these services, SMHAs develop 

systems and services to help persons with mental illness recover from their 

illness and lead fulfilling lives in the community. To assist consumers in 

the recovery process, SMHAs provide acute and long-term mental health 

treatment, plus a variety of community-based support services including 

supportive employment, housing, and education. In doing so, SMHAs 

organize and coordinate larger state systems that also provide mental health 

services and supports to persons with mental illnesses. However, SMHAs are 

increasingly constrained in their ability to manage the public mental health 

system by a variety of historical trends in organization and financing. 

Over the last 25 years, most new funds to 

SMHA systems have come from Medicaid, a 

reimbursement system that pays for services 

along an insurance model, unlike traditional 

state general revenue funds that went to the 

SMHAs, which then controlled the 

expenditures for services. From 1981 to 

2005, the share of SMHA funding from state 

general revenue sources declined from 75 

percent to 47 percent, while Medicaid grew 

from 13.5 percent to 42 percent. As a result 

of this shift, Medicaid has become an 

important new funder of SMHA mental 

health services. While Medicaid has provided 

critical new resources to finance mental 

health services, the funds come with a new 

set of payment rules and requirements 

established by the Medicaid program and 

thus may reduce the SMHA’s autonomy and 

control over the public mental health system.

In addition to having direct control over 

only parts of their financing, SMHAs vary 

widely in their involvement in the licensing 

and monitoring of public and private mental 

health providers that make up the specialty 

mental health systems in states. In 2007, 21 

SMHAs were responsible for licensing private 

mental health providers; in the remaining 

states, this task was the responsibility of a 

separate state licensing or health department. 

SMHAs have evolved greatly over the last 

century, from government entities that 

devoted nearly all their human and fiscal 
8 Funding and Characteristics of State Mental Health Agencies, 2007

resources to the provision of inpatient care in 

large state psychiatric hospitals to the present 

where they support community-based 

provider agencies that receive SMHA funds, 

and where the SMHA organizes systems and 

monitors the quality of the care. As persons 

with mental illness were moved out of state 

psychiatric hospitals, SMHAs began to 

broaden their focus from primarily providing 

inpatient services in large state hospitals to 

providing community-based mental health 

treatment and coordinating or providing 

essential support services to help persons 

with mental illness live in the community. 

SMHAs today are providing housing and 

housing supports, employment and education 

supports, and other supports beyond the 

traditional mental health treatments that 

were the focus in the past.

SMHAs vary widely in where they are 

organizationally located in state government 

and in the service and disability 

responsibilities they are assigned. Every 

SMHA shares some common elements. 

SMHAs:

■ Operate inpatient psychiatric beds that 

provide critical services to individuals who 

are at risk of harm to themselves and or/

others.

■ Oversee and fund community-based 

mental health services to meet the needs of 

individuals within their states. In some 

states, community mental health services 

are delivered directly by the SMHA, with 

state employees delivering these services. 

The more common method for providing 

community mental health services is an 

arrangement where the SMHA provides 

funds and leadership to local mental 

health agencies or authorities that then 

deliver services using a mixture of 

providers—often private, not-for-profit 

specialty mental health centers.

■ Are responsible for planning the 

development of an array of comprehensive 

mental health services and submitting an 

annual community Block Grant plan to 

the Federal government.

■ Are working with other state and Federal 

government agencies to ensure the 

provision of essential mental health, 

health, and support services to persons 

with mental illnesses.

■ In most states, play a key public health 

role in informing the residents of their 

state about the risks of mental illness, 

reducing stigma, preventing suicide, and 

encouraging needed treatments.

■ Serve a public safety function in providing 

and coordinating services to individuals 

determined by the courts to be dangerous 

to themselves or others. In most states, the 

SMHA is also responsible for providing 

mental health treatments to persons 

identified by the criminal justice system as 

requiring mental health forensic services 

(such as persons found incompetent to 

stand trial, persons found not guilty by 

reason of insanity, persons found guilty 

but mentally ill, and persons found eligible 

for commitment to psychiatric facilities as 

sexual offenders or violent sexual 

predators).

1.1 Impacts on SMHAs’ Areas of 

Focus

In the last decade, several landmark 

reports have been produced highlighting new 

and expanded areas of focus for SMHAs. A 

Surgeon General’s report on mental illness 

(US DHHS, 1999) highlighted the latest 
Funding and Characteristics of State Mental Health Agencies, 2007 9

knowledge about state-of-the-art treatments 

to persons with mental illnesses. The report 

also revealed that many people with SMI and 

children with SED were not receiving any 

mental health services, and that even those 

people who received services often were not 

receiving the best evidence-based services. A 

critical message to the states and advocates 

of the Surgeon General’s report was that 

mental health treatments do work, and 

persons with mental illnesses can recover

and live productive and rewarding lives in 

their communities. The report was used in 

many states to focus attention on improving 

the availability of evidence-based practices 

(EBPs) and on public health functions of 

SMHAs (suicide prevention, addressing 

unmet needs, improving the cultural 

competence of services, and addressing 

stigma related to mental illnesses).

The President’s New Freedom Commission 

(PNFC) report on mental health (US DHHS, 

2003) laid out six major goals for a 

transformed mental health system (see 

Section VII, New Freedom Commission 

Activities). These goals have been embraced 

and endorsed by the SMHAs through their 

membership organization, the National 

Association of State Mental Health Program 

Directors (NASMHPD). The Federal 

government has provided leadership to work 

with the states to implement the 

transformation goals of the PNFC. CMHS 

has provided a set of Mental Health 

Transformation State Incentive Grants (MHT 

SIG) to nine states to help them implement 

the goals of the PNFC.

CMHS’s Transforming Mental Health 

Care in America, the Federal Action Agenda: 

First Steps (2005) identified a series of 

leadership steps being undertaken by 

SAMHSA and partner Federal agencies, 

including Education, Medicaid, Labor, and 

others. The major focus of the Federal Action 

Agenda is empowering and working with 

SMHAs to transform the delivery of mental 

health services.

With the release of the Surgeon General’s 

Report, the PNFC, and the Federal Action 

Agenda, a new and broader mission for 

SMHAs has become apparent. SMHAs are 

being asked to exert leadership in public 

mental health services in several areas:

■ Building mental health service systems 

that promote and support recovery and 

resilience of mental health consumers

■ Providing culturally competent services

■ Working beyond the traditional specialty 

mental health system to reduce the 

fragmentation in service delivery and 

eliminate barriers to consumers receiving 

mental health services

■ Bringing the physical and mental health 

needs of consumers together to ensure 

both sets of needs are being met

■ Focusing on accountability and outcomes 

from mental health services

■ Focusing on public safety related to mental 

illness, including mental health courts, 

involuntary outpatient commitment 

statutes, and commitment and treatment 

for sexual offenders

1.2 Outline of This Report

Section II reviews the methodology used 

for collecting the data for this report and the 

limitation of the data.

Section III discusses the organization and 

structure of SMHAs, including their location 

within state government, their disability 

service responsibilities, their reorganization, 
10 Funding and Characteristics of State Mental Health Agencies, 2007

their eligibility determination for mental 

health services, and the number of mental 

health organizations they fund and/or 

operate.

Section IV provides a discussion of the 

characteristics of persons served by the 

SMHAs in fiscal year 2007.

Section V presents the SMHAs’ 

responsibilities for community mental health 

services.

Section VI reviews other SMHA policy 

initiatives with a focus on state psychiatric 

hospitals.

Section VII addresses SMHAs’ initiatives 

related to the six goals of the PNFC.

Section VIII reviews the funding sources 

and expenditures of SMHAs.

Section IX discusses the SMHAs’ activities 

working with other state agencies.

The Appendix (on CD and SAMHSA 

website, www.samhsa.gov) provides 

individual SMHA profiles that show how 

each SMHA is organized within the state 

government, the SMHA responsibilities and 

roles, the number and characteristics of the 

persons served, and the financing of the 

services.
II. Study Approach and 

Limitations

This section provides a description of the study approach and 

limitations of the information sources.

2.1 Study Approach

This report utilizes the 2007 cycle of the 

SMHA Profiling System (SPS) (NRI, 2008) 

and The FY 2005 State Mental Health 

Revenue and Expenditure Study Results

(NRI, 2007) as primary sources of data. 

These primary sources are supplemented 

with data from the Uniform Reporting 

System (URS) (CMHS, 2008) to describe the 

clients served by the SMHAs.

2.2 SMHA Profiling System

The SPS is a database containing 

information describing the organization, 

funding, operation, services, policies, 

statutes, and clients of SMHAs. The 

database describes each SMHA’s 

organization and structure, service systems, 

eligible populations, emerging policy issues, 

number of clients served, fiscal resources, 

client issues, information management 

structures, and the research and evaluation it 

conducts. Questions are grouped into 12 

components by topical area to facilitate 

SMHA review and completion of the 

profiles. Questions within each component 

address the specific needs of SMHA 

managers and others interested in public 

mental health systems, and they support 

decision-making, policy analysis, research, 

and evaluation. 

Guided by an expert panel, the National 

Association of State Mental Health Program 

Directors Research Institute, Inc. (NRI), 

revised SPS’s 12 components (New Freedom 

Commission; Organization and Structure; 

Policy; Client; Services; Forensic; Workforce; 

Financial; Managed Behavioral Healthcare; 

Research and Evaluation; Information 

Management; and National Outcome 

Measures) for the 2007 information update 

cycle. The revised components were then sent 

to all SMHA commissioners/directors and 

their agencies’ designated SPS contact 

persons for completion during 2007. States 

were offered several methods of data 

submission: They were given the option to 

input the requested information through the 

NRI-developed SPS online data entry system, 

or complete the questions on the forms and 

fax, mail, or e-mail the completed forms to 

NRI. Individual state responses to the 

profiles are available on NRI’s website at 

www.nri-inc.org, where users can access 

state responses by keyword, state, and special 

topical reports.

Funding and Characteristics of State Mental Health Agencies, 2007 11
12 Funding and Characteristics of State Mental Health Agencies, 2007

2.3 SMHA-Controlled Revenue and 

Expenditure Study

The Revenue and Expenditure Study

describes the major expenditures and funding 

of the SMHAs. Every year, NRI works with 

the SMHAs to document the expenditures 

for mental health services controlled by the 

SMHAs and the major funding sources for 

these expenditures. The methodology for this 

effort is predicated on compiling actual 

(rather than estimated) revenues and 

expenditures under the direct control of the 

SMHA. The depiction of actual figures is 

considered necessary for reporting valid and 

reliable data. Without reference to specific 

financial reports indicating actual 

expenditures, it is difficult, if not impossible, 

to both verify figures and have an accessible 

database for followup and/or analysis.

A set of Excel spreadsheets containing 

four tables with built-in data edits serves as 

the data collection instrument for the 

Revenue and Expenditure Study. The tables 

depict the mental health expenditures and 

revenues under the control of the SMHA. 

The funds include all state general funds to 

the SMHA, the Federal Mental Health Block 

Grant, local funds (when required) to match 

state dollars, other funds the SMHA 

controls, and the total expenditures and 

revenues of the community mental health 

system. For the purposes of this report, the 

fiscal year (FY) 2005 cycle of the Revenue 

and Expenditure Study data received from 

the 50 states and the District of Columbia is 

used to discuss the expenditures and funding 

sources of SMHAs.

2.4 The Uniform Reporting System

CMHS’s Uniform Reporting System (URS) 

(CMHS, 2008) is a Federal reporting system 

used by SMHAs to compile and report 

annual data from each state as part of the 

SAMHSA/CMHS Federal Community 

Mental Health Block Grant. The URS is part 

of the Mental Health Block Grant 

Implementation Report, approved by the 

Office of Management and Budget (OMB), 

which SMHAs are required to submit to 

CMHS every December 1. The URS is part 

of an effort to use data in decision support 

and planning in public mental health systems 

and to support program accountability.

The URS, composed of 21 tables 

developed by the Federal government in 

consultation with SMHAs, compiles annual 

state-by-state and national aggregate 

information, including numbers and 

sociodemographic characteristics of persons 

served by the states, the outcomes of care, 

use of selected EBPs, client assessment of 

care, and insurance status. The tables are 

used by SAMHSA to calculate the 10 mental 

health National Outcome Measures (NOMs) 

for state and national reporting. For the 

purposes of this report, 2007 data submitted 

by the 50 states, the District of Columbia, 

and 7 U.S. territories are used to describe 

clients served by the SMHAs.

2.5 Limitations

While there was a high response rate for 

each of the SPS components, the level of 

completion of each component varied across 

states. Some states did not provide answers 

to all questions asked; therefore, some 

information presented in this report is based 

on responses from less than the total number 

of reporting states.

The SPS components on Information 

Management and NOMs were completed by 

all 50 states and the District of Columbia; 

the Organization and Finance components 
Funding and Characteristics of State Mental Health Agencies, 2007 13

were completed by 50 states (including the 

District of Columbia); the Managed Care 

component was completed by 48 states; the 

Policy, Services, New Freedom Commission, 

and Forensic components were completed by 

47 states each; the Client and Workforce 

components were completed by 45 states.

While this report focuses on SMHAcontrolled expenditures, it should not be 

assumed that the revenues and expenditures 

reported here include all expenditures for 

mental health services within a state 

government. State governments expend 

considerable resources to provide mental 

health services through other state 

government agencies not included in this 

report.

The major state government expenditure 

not fully depicted in this report is Medicaid, 

one of the fastest growing expenditures of 

state governments in the last 20 years. 

Mental health services constitute a significant 

part of this Medicaid growth. Medicaid’s 

billing and reporting systems do not 

differentiate mental health from any other 

physical health services reimbursed by 

Medicaid. While some SMHAs and state 

Medicaid agencies have conducted thorough 

analyses of Medicaid-paid claims files to 

determine total Medicaid expenditures for 

mental health, many of these expenditures 

are outside the control of the SMHA or the 

community mental health system the SMHA 

funds. The Medicaid expenditures included 

in this report are limited to the portion of 

Medicaid expenditures controlled or 

administered by the SMHAs. Studies by 

CMHS on Medicaid suggest that total 

Medicaid expenditures for mental health 

may be double that controlled by SMHAs.

An additional limitation of the revenue 

and expenditure data is the reporting period. 

While the SPS information and URS data 

used in this report come from the 2007 cycle, 

data for revenues and expenditures are based 

on actual expenditures data from state FY 

2005.

Funding and Characteristics of State Mental Health Agencies, 2007 15

III. Organization and 

Structure of SMHAs

The organizational location and structure of SMHAs, their specific 

mental health responsibilities, and the extent to which they are 

responsible for disability services beyond mental health vary 

widely among states. When considering SMHA systems, it is important to 

understand the role and unique responsibilities of the SMHA in each state.

Over the last 25 years, many SMHAs have 

been reorganized as a division or agency 

within a larger umbrella agency. This 

reorganization has occurred as Governors 

and state legislatures moved mental health 

services together with substance abuse 

services and put the mental health agency 

under the same umbrella as one of its major 

funding sources—Medicaid. See Table 1 for 

a state-by-state listing of the SMHAs’ 

organization and structure and their 

relationship to substance abuse and 

developmental disabilities/mental retardation 

agencies.

3.1. Location of SMHAs Within State 

Government

As noted above, state mental health 

agencies are most often administratively 

located within a larger umbrella agency. In 

2007, 29 SMHAs were located within state 

departments of human services, 7 were in 

health departments, and 2 were in some 

other state department, often one combining 

health and human services. In 13 states, the 

SMHAs were independent departments of 

mental health. 

In 12 states, the SMHA’s director is a 

member of the Governor’s Cabinet. In 8 

states, the SMHA’s director is directly 

accountable to the governor; in 38 SMHAs, 

the director is accountable to another 

administrator such as the Cabinet secretary 

of the umbrella agency; and in 5 SMHAs, 

the director is accountable to other 

leadership such as the mayor.

3.1.1 Mental Health Boards/Commissions

In seven states, the SMHA’s director 

reports to a mental health board or 

commission (Connecticut, Missouri, 

Oklahoma, South Carolina, Utah, Vermont, 

and Wisconsin). A mental health board or 

commission is charged with overseeing the 

activities of the SMHA in 18 states. These 

mental health boards are usually appointed 

by the Governor (13 states), or jointly 

appointed by the Governor and legislature (3 

states); in 4 states, the board members are 

approved by the legislature.
Table 1: SMHA Organization, Structure, and Relationship to Substance Abuse and Mental 

Retardation/Developmental Disabilities Agencies

State

SMHA Organization and Structure SMHA Relationship to AOD 

and MR/DD* Agency

SMHA Located in 

State Department

Levels Between 

Commissioner 

and Governor

SMHA Director 

Reports to MH 

Board/Council

Alcohol and Drug 

Abuse MR/DD*

AL Independent Agency 0 No Part of SMHA Part of SMHA

AK Human Services 2 No Same umbrella Same umbrella

AZ Health Department 1 No Part of SMHA Other agency

AR Human Services 2 No Part of SMHA Same umbrella

CA Independent Agency 1 No Other agency Other agency

CO Human Services 2 No Part of SMHA Same umbrella

CT Independent Agency 0 Yes Part of SMHA Other agency

DE Human Services 1 No Part of SMHA Same umbrella

DC Independent Agency 0 No Other agency Other agency

FL Human Services 3 No Same umbrella Other agency

GA Human Services 1 No Part of SMHA Part of SMHA

HI Health Department 1 No No response Same umbrella

ID Human Services 2 No Same umbrella Same umbrella

IL Human Services 3 No Same umbrella Same umbrella

IN Human Services 1 No Part of SMHA Same umbrella

IA Human Services 1 No Other agency Part of SMHA

KS Human Services 2 No Part of SMHA Part of SMHA

KY Human Services 2 No Part of SMHA Part of SMHA

LA Health Department 1 No Same umbrella Same umbrella

ME Human Services 2 No Same umbrella Same umbrella

MD Health Department 2 No Same umbrella Same umbrella

MA Independent 1 No Same umbrella Same umbrella

MI Other Department 1 No Same umbrella Part of SMHA

MN Human Services 2 No Same umbrella Same umbrella

MS Independent Part of SMHA Part of SMHA

MO Independent 1 Yes Part of SMHA Part of SMHA

MT Human Services 2 No Same umbrella Same umbrella

NE Human Services 1 Part of SMHA No response

NV Human Services 1 No Part of SMHA Part of SMHA

NH Human Services 3 No Same umbrella Same umbrella

NJ Human Services 1 No Same umbrella Same umbrella

NM Human Services 0 No Part of SMHA Other agency

NY Independent 0 No Other agency Other agency

NC Human Services 1 No Part of SMHA Part of SMHA

ND Human Services 1 No Part of SMHA Same umbrella

OH Independent 0 No Other agency Other agency

OK Independent 1 Yes Part of SMHA Other agency

OR Human Services 1 No Part of SMHA Same umbrella

PA Human Services 1 No Other agency Same umbrella

RI Human Services 1 No Part of SMHA Part of SMHA

SC Independent 1 Yes Other agency Other agency

SD Human Services 1 No Same umbrella Same umbrella

TN Independent 0 No Part of SMHA Other agency

TX Health Department 2 No Part of SMHA Same umbrella

UT Human Services 2 Yes Part of SMHA Same umbrella

VT Health Department 2 Yes Same umbrella Other agency

VA Independent 1 Part of SMHA Part of SMHA

WA Human Services 1 No Same umbrella Same umbrella

WV Other Department. 1 No Part of SMHA Part of SMHA

WI Human Services 1 Yes Part of SMHA Same umbrella

WY Health Department 1 No Same umbrella Same umbrella

Independent = 13 0 (Direct Gov) = 7 Yes = 7 Part of SMHA = 26 Part of SMHA = 13

Human services = 29 One level = 27 No = 41 Same umbrella = 17 Same umbrella = 25

Health department = 7 Two levels = 13 No response = 3 Other agency = 7 Other agency = 12

Other structure = 2 Three + levels = 3 No response = 1 No response = 1

No response = 1

*MR/DD = Mental retardation/developmental disabilities

16 Funding and Characteristics of State Mental Health Agencies, 2007
Funding and Characteristics of State Mental Health Agencies, 2007 17

3.2 Other Disability Service 

Responsibilities of SMHAs 

Many SMHAs are responsible for other 

disabilities in addition to mental health, with 

the two most common being substance abuse 

services and mental retardation/

developmental disabilities (MR/DD). Over 

the last 20 years, many SMHAs have had 

responsibilities for MR/DD services moved 

out, and several have had substance abuse 

services combined.

3.2.1 Substance Abuse Services Colocated 

With Mental Health Services

In 28 states, the SMHA is also responsible 

for the provision of substance abuse 

treatment services (including alcohol and 

other drug abuse), and the two agencies are 

located within the same state umbrella 

agency in 17 additional states (see Figure 1). 

In six states, interagency agreements exist 

between the SMHA and substance abuse 

agencies to coordinate care (Florida, Illinois, 

Massachusetts, New Jersey, New York, 

Ohio).

In 13 states, the SMHA is also responsible 

for the provision of MR/DD, and the MR/

DD agency is located within the same 

umbrella agency as the SMHA in 25 states. 

In 11 states, all 3 disability services are 

organized together within the SMHA (see 

Figure 2).

Figure 1: SMHA Responsibilities for Substance Abuse and MR/DD Services 

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure1.html
18 Funding and Characteristics of State Mental Health Agencies, 2007

Figure 2: Number of States With Mental Health and Substance Abuse Colocated in One Agency: 

1981 to 2007 

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure2.html

3.3 Reorganization of SMHAs

Within the last 2 years, nine SMHAs have 

been organizationally relocated within state 

government (Colorado, Florida, Kansas, New 

Jersey, New Mexico, Rhode Island, 

Tennessee, Texas, Washington). In six states 

(Colorado, Nevada, Tennessee, Vermont, 

Florida, Kentucky), the reorganization 

involved shifting additional disability services 

into or out of the SMHA. For example, in 

Nevada, substance abuse services were 

moved into the SMHA, and in Florida, the 

Agency for Persons with Disabilities was 

created, and services for persons with mental 

retardation were moved out of the SMHA. 

Twenty years ago, substance abuse was 

colocated with mental health in 19 states. 

During the 1980s and early 1990s, the trend 

was to split mental health and substance 

abuse into separate agencies. However, in the 

later 1990s and this decade, this trend has 

reversed and more states have reorganized to 

place mental health and substance abuse in 

the same agency, while separating mental 

retardation services into a separate state 

agency.

When substance abuse and mental health 

services are combined into a single state 

agency, the most common rationale is to 

better coordinate co-occurring mental 

health/substance abuse services and to move 

the system towards a behavioral health focus 

that better addresses both the mental health 

and substance abuse needs of a state’s 

consumers. For example, Tennessee’s 

reorganization to place substance abuse 
Funding and Characteristics of State Mental Health Agencies, 2007 19

together with mental illnesses was justified as 

follows:

Integrating alcohol and drug abuse services 

within [Tennessee Department of Mental Health 

and Developmental Disabilities (TDMHDD)] will 

streamline government and its resources by 

ensuring that clinical services are coordinated, 

communication is improved, and incentives 

effectively aligned for populations in need for 

which there is tremendous overlap. This transfer 

will also facilitate the opportunity to expand 

access to integrated treatment options that focus 

on the whole person especially for persons with 

co-occurring disorders (TDMHDD, 2007).

3.4 SMHA Mental Health 

Responsibilities

SMHAs vary widely in the specific array 

of mental health services they are responsible 

for. Some are responsible for mental health 

services across the life span—children, 

adults, and older adults. In some states, 

responsibilities for specific types of mental 

health services, such as forensics, brain 

injuries, or Alzheimer’s disease, are carved 

out to a different state agency and are not 

part of the SMHA’s mission.

3.4.1 Children/Adolescent Mental Health 

Services

In most states (30), the SMHA is 

responsible for both adult and child/

adolescent mental health services; however, 

in 3 states (Connecticut, Delaware, and 

Rhode Island), the responsibility for 

providing mental health services to children/

adolescents has been split out into a separate 

state agency, usually a department of 

children and families. The concept behind 

these children and families departments is to 

put the responsibility of children’s mental 

health services into a single agency that is 

also responsible for child welfare, juvenile 

justice, and other related social and health 

services for children. In 16 states, the 

responsibility for mental health services for 

children and adolescents is shared between 

the SMHA and another state agency.

3.4.2 State Psychiatric Hospitals

In every state, there are state-owned-andoperated psychiatric inpatient beds that are 

used for persons in need of the most intensive 

level of mental health services. In most states 

(44), the operation of state psychiatric 

hospitals is part of the SMHA’s 

responsibilities. In six states (Colorado, New 

Hampshire, New Mexico, Rhode Island, 

South Dakota, and Wyoming), a separate 

state government agency has this 

responsibility. In these states, the SMHA 

works with the state psychiatric hospitals 

and the other state agency to coordinate care 

between the state psychiatric hospital(s) and 

the SMHA’s community mental health 

system. These states describe having special 

initiatives to help coordinate the movement 

of consumers out of the psychiatric facilities 

back into community mental health services.

3.4.3 Forensic Mental Health Services

Forensic mental health services are 

provided to persons found in need of mental 

health services by a court through the 

criminal justice system. Forensic services 

range from evaluations of competency to 

stand trial to providing mental health 

services to persons found by courts to be not 

competent to stand trial, not guilty by reason 

of insanity, and/or guilty but mentally ill. In 

most states (34), the provision of forensic 

mental health services is the responsibility of 

the SMHA; in 13 states, this responsibility is 

shared with another agency; and in 2 states, 

the responsibility lies with the state 

department of corrections and is not part of 

the SMHA’s service mission.
20 Funding and Characteristics of State Mental Health Agencies, 2007

3.4.4 Alzheimer’s Disease and Organic Brain 

Syndrome

In 17 states, responsibility for providing 

services to persons with Alzheimer’s and 

organic brain syndrome (OBS) is shared with 

another state government agency (often the 

state health department), and in 32 states, 

the SMHA has no responsibility for such 

services. However, even in states where the 

SMHA does not have responsibility for 

providing Alzheimer’s and OBS services, 

data from state psychiatric hospitals often 

show that patients with these diagnoses are 

being served in the state hospitals. This is 

often because the patients may have 

co-occurring mental health diagnoses or 

because there are no alternative placements.

3.4.5 Traumatic Brain Injury Services

In four states, the SMHA is responsible 

for providing services to individuals with 

traumatic brain injuries (TBI). In 20 states, 

the responsibility for providing such services 

is shared between the SMHA and another 

state government agency, and in 24 states, 

the SMHA has no responsibility for these 

services. Table 2 provides each SMHA’s 

responsibilities for mental health–related 

disability.

3.5 Eligibility for SMHA Mental 

Health Services

SMHAs vary in their eligibility criteria 

regarding those who can receive mental 

health services from SMHA-operated or 

SMHA-funded providers (see Table 3).

3.5.1 Adult Mental Health Eligibility

Most states have some form of eligibility 

criteria for adults receiving public mental 

health services. In 19 states, mental health 

services using state general or special funds 

are limited to adults with SMI, while in 21 

states there are eligibility criteria for both 

adults with SMI and adults with any mental 

illness. For services funded with nonstate 

sources such as Medicaid, fewer states (13) 

restrict eligibility to only adults with SMI, 

while 25 states have eligibility criteria for 

both adults with SMI and adults with any 

mental illness.

States use a mixture of specific diagnoses, 

functional status, and other criteria to 

establish eligibility for adults receiving 

SMHA-funded or SMHA-operated mental 

health services. In 44 states, specific 

diagnoses are part of the eligibility criteria. 

In 40 states, an adult’s functional status is 

part of the eligibility criteria, and in 11 states 

some other additional criteria are used to 

establish eligibility (such as duration of 

illness, history of prior hospitalization, 

income, and risk).

3.5.2 Child and Adolescent Eligibility

In 17 states, mental health services using 

state general or special funds are limited to 

children with SED, while in 22 states there 

are eligibility criteria for both children with 

SED and children with any emotional 

disturbance. For services funded with 

nonstate sources such as Medicaid, fewer 

states (12) restrict eligibility to only children 

with SED, while 26 states have eligibility 

criteria for both children with SED and 

children with any emotional disturbance.

States use a mixture of specific diagnoses, 

functional status, and other criteria to 

establish eligibility for children’s mental 

health services. In 39 states, specific 

diagnoses are part of the eligibility criteria. 

In 37 states, the child’s/adolescent’s 

functional status is part of the eligibility 

criteria, and in 8 states some other additional 
Funding and Characteristics of State Mental Health Agencies, 2007 21

Table 2: SMHA Mental Health–Related Responsibilities

State Children's Mental 

Health in SMHA

Alzheimer's Disease/

Organic Brain 

Syndrome

Traumatic Brain 

Injury

State Psychiatric 

Hospitals Forensics

AK Part of SMHA No responsibility Part of SMHA Part of SMHA Part of SMHA

AL Part of SMHA Responsibility shared No responsibility Part of SMHA Part of SMHA

AR Part of SMHA No responsibility No responsibility Part of SMHA Part of SMHA

AZ Part of SMHA No responsibility No responsibility Part of SMHA Responsibility shared

CA Part of SMHA No responsibility Part of SMHA Part of SMHA Part of SMHA

CO Responsibility shared No responsibility Responsibility shared Responsibility shared Responsibility shared

CT No responsibility No responsibility Responsibility shared Part of SMHA Part of SMHA

DC Responsibility shared No responsibility No responsibility Part of SMHA Part of SMHA

DE No responsibility No responsibility Responsibility shared Part of SMHA Responsibility shared

FL Part of SMHA No responsibility No responsibility Part of SMHA Part of SMHA

GA Responsibility shared No responsibility No responsibility Part of SMHA Part of SMHA

HI Part of SMHA No responsibility No responsibility Part of SMHA Part of SMHA

IA Part of SMHA No responsibility Responsibility shared Part of SMHA No responsibility

ID Part of SMHA No responsibility No responsibility Part of SMHA Responsibility shared

IL Part of SMHA No responsibility No responsibility Part of SMHA Part of SMHA

IN Part of SMHA No responsibility No responsibility Part of SMHA Responsibility shared

KS Part of SMHA Responsibility shared Responsibility shared Part of SMHA Responsibility shared

KY Part of SMHA Responsibility shared Responsibility shared Part of SMHA Part of SMHA

LA Part of SMHA No responsibility No responsibility Part of SMHA Part of SMHA

MA Responsibility shared No responsibility No responsibility Part of SMHA Part of SMHA

MD Part of SMHA Responsibility shared Responsibility shared Part of SMHA Part of SMHA

ME Part of SMHA No responsibility No response Part of SMHA Part of SMHA

MI Part of SMHA Responsibility shared Responsibility shared Part of SMHA Responsibility shared

MN Part of SMHA No responsibility Responsibility shared Part of SMHA Part of SMHA

MO Responsibility shared Responsibility shared Responsibility shared Part of SMHA Part of SMHA

MS No response No response No response No response No response

MT Responsibility shared Responsibility shared No responsibility Part of SMHA Responsibility shared

NC Part of SMHA Responsibility shared Part of SMHA Part of SMHA Part of SMHA

ND Responsibility shared No responsibility Responsibility shared Responsibility shared Responsibility shared

NE Responsibility shared No response No response Part of SMHA No response

NH Responsibility shared No responsibility No responsibility Responsibility shared Responsibility shared

NJ Responsibility shared Responsibility shared Responsibility shared Part of SMHA Part of SMHA

NM Responsibility shared Responsibility shared Responsibility shared Responsibility shared Responsibility shared

NV Responsibility shared No responsibility Responsibility shared Part of SMHA Part of SMHA

NY Part of SMHA No responsibility No responsibility Part of SMHA Part of SMHA

OH Part of SMHA No responsibility No responsibility Part of SMHA Part of SMHA

OK Part of SMHA No responsibility No responsibility Part of SMHA Part of SMHA

OR Part of SMHA Responsibility shared Responsibility shared Part of SMHA Part of SMHA

PA Part of SMHA No responsibility Part of SMHA Part of SMHA Part of SMHA

RI No responsibility Responsibility shared Responsibility shared No response Part of SMHA

SC Responsibility shared Responsibility shared Responsibility shared Part of SMHA Part of SMHA

SD Part of SMHA Responsibility shared No responsibility No responsibility No responsibility

TN Part of SMHA No responsibility No responsibility Part of SMHA Part of SMHA

TX Part of SMHA No responsibility No responsibility Part of SMHA Part of SMHA

UT Responsibility shared No responsibility Responsibility shared Part of SMHA Part of SMHA

VA Part of SMHA Responsibility shared No responsibility Part of SMHA Part of SMHA

VT Responsibility shared Responsibility shared Responsibility shared Part of SMHA Responsibility shared

WA Responsibility shared No responsibility No responsibility Part of SMHA Part of SMHA

WI Part of SMHA No responsibility No responsibility Part of SMHA Part of SMHA

WV Part of SMHA Responsibility shared Responsibility shared Part of SMHA Part of SMHA

WY Part of SMHA No responsibility No responsibility Responsibility shared Responsibility shared

Part of the SMHA = 31 Part of the SMHA = 0 Part of the SMHA = 4 Part of the SMHA = 43 Part of the SMHA = 34

Responsibility shared = 16 Responsibility shared = 17 Responsibility shared = 20 Responsibility shared = 5 Responsibility shared = 13

No responsibility = 3 No responsibility = 32 No responsibility = 24 No responsibility = 1 No responsibility = 2

No response = 1 No response = 2 No response = 3 No response = 2 No response = 2
22 Funding and Characteristics of State Mental Health Agencies, 2007

Table 3: Eligibility Criteria to Receive Mental Health Services From SMHA-Operated/SMHAFunded Providers

State

Adults Children

Eligibility Criteria 

for Serving Adults 

Using State 

General Fund/

Special Fund 

Dollars

Eligibility Criteria 

for Serving Adults 

Using Other Funds 

(Including 

Medicaid)

What Factors 

Are Part of the 

SMHA's 

Determination 

of SMI?*

Eligibility Criteria 

for Serving Children 

Using State General 

Fund/Special Fund 

Dollars

Eligibility Criteria 

for Serving 

Children Using 

Other Funds 

(Including 

Medicaid)

What Factors 

Are Part of the 

SMHA's 

Determination 

of SED?*

AK Adults with SMI Adults with SMI D and F Children with SED Children with SED D and F

AL Adults with SMI Adults with SMI D Children with SED Children with SED D

AR No eligibility criteria No eligibility criteria D and F No eligibility criteria No eligibility criteria D and F

AZ Both Both D and F Both Both D

CA Both No response D Both No response No response

CO Both Both D and F Both Both F

CT Adults with SMI No response D and F Both No response D and F

DC No response No response No response Non-SED Children No response D, F, and O

DE Both Both D, F, and O Both Both D and F

FL Non-SMI adults No response D No response No response No response

GA Adults with SMI Adults with SMI D and F Children with SED Children with SED D and F

HI Adults with SMI Adults with SMI D and F Children with SED Children with SED D and F

IA No eligibility criteria No eligibility criteria D No eligibility criteria No eligibility criteria D

ID Adults with SMI Both D and F Children with SED Both D and F

IL Both Both D, F, and O Both Both D, F, and O

IN Adults with SMI Both F and O Children with SED Both F and O

KS Both Non-SMI adults D, F, and O Both Non-SED Children F and O

KY Both Adults with SMI D, F, and O Both Children with SED D and F

LA Adults with SMI Adults with SMI D and F Children with SED Children with SED D and F

MA Adults with SMI Both D and F Children with SED Both D and F

MD Both Both D and F Both Both D and F

ME Both Both D and F Both Both D and F

MI Adults with SMI Adults with SMI D and F Children with SED Children with SED D and F

MN Adults with SMI Both D and F Children with SED Both D and F

MO Adults with SMI Non-SMI adults D Children with SED Non-SED Children D

MS No response No response No response No response No response No response

MT Adults with SMI Both D and F Children with SED Both D and F

NC Adults with SMI Both D and F Children with SED Both D and F

ND Both Both F Both Both D and F

NE No response No response No response No response No response No response

NH Adults with SMI Adults with SMI D and F Children with SED Both D and F

NJ Both No response D and F No response No response No response

NM Both Both D and F Both Both D and F

NV Adults with SMI Adults with SMI D and F Children with SED Children with SED D and F

NY Both Both D and F Both Both D and F

OH Both Both D, F, and O Both Both No response

OK Both Both D and F Both Both D and F

OR Adults with SMI Both D and F Both Both D and F

PA Both Both D and F Both Both D and F

RI Non-SMI adults Non-SMI adults D and F No response No response No response

SC No response Both No response No response Both D

SD Adults with SMI Both D and F Children with SED Both D and F

TN No eligibility criteria No eligibility criteria D and F No eligibility criteria No eligibility criteria D and F

TX Adults with SMI Adults with SMI D, F, and O Children with SED Children with SED D, F, and O

UT Both Both D Both Both D

VA No eligibility criteria Adults with SMI D, F, and O No eligibility criteria Children with SED D, F, and O

VT Both Both D, F, and O Both Both D, F, and O

WA Both Adults with SMI D and F Both Children with SED D and F

WI Both Both F Both Both F

WV Both Both D and O Both Both D, F, and O

WY No eligibility criteria Adults with SMI D and F No eligibility criteria Children with SED No criteria

Both** 21 25 22 26

SMI 19 13 17 12

Non-SMI 2 3 1 2

No criteria 5 3 5 3

No response 4 7 6 8

*(D= Specific diagnoses, F = Functional status, O = Other factors)

** Both for adults = SMI and non-SMI; Both for children = SED and non-SED
Funding and Characteristics of State Mental Health Agencies, 2007 23

criteria are used to establish eligibility 

(duration of illness; history of prior 

hospitalization, income, and risk are other 

criteria states use). 

3.6 Number of Mental Health 

Organizations Operated and/or 

Funded by SMHAs

In 2007, SMHAs funded and/or operated 

11,681 mental health organizations (see 

Table 4). SMHAs work with a mix of types 

of mental health providers ranging from state 

psychiatric hospitals staffed by the state and 

operated by the SMHA, to a variety of 

county-based or city-based providers and a 

mixture of for-profit and not-for-profit 

community organizations. Most of the 

organizations making up the SMHA system 

are not operated by the SMHA, but instead 

receive funds from the SMHA. In a few 

states, the SMHA operates community 

mental health organizations that are stateowned (with state employees delivering the 

mental health services). During 2007, there 

were 338 community mental health 

organizations operated by SMHAs in 16 

states.

3.6.1 SMHA Relationship to Local Providers

In addition to funding and operating 

mental health organizations, in 21 states, the 

SMHA is responsible for licensing or 

certifying private mental health providers. In 

18 of these states, the SMHA receives reports 

on the services provided by the private 

mental health providers. Thirty-eight 

SMHAs reported the initiatives the SMHAs 

were undertaking to integrate public and 

private providers over the next year. 

Examples of these initiatives are shown in 

Table 5.

3.6.2 Privatization of SMHA-Operated 

Programs

In recent years, several states have 

explored privatizing some of their stateowned-and-operated mental health 

programs. Two states (Florida and Kansas) 

reported that within the last year they had 

privatized one of their state-operated 

psychiatric hospitals. In Florida, the Treasure 

Coast Forensic Treatment Facility was 

entirely privatized, and in Kansas, the 

Rainbow Mental Health Facility children’s 

program was privatized. Three states 

(Kansas, North Carolina, and South Dakota) 

reported they had privatized one or more of 

their state-operated community mental 

health programs.

3.6.3 SMHA Class Action Lawsuits

Class action lawsuits regarding mental 

health services are an additional important 

driver of policy. In 2007, 27.1 percent of 

SMHAs (13 of 48) reported they were 

involved in a class action lawsuit. Several of 

these suits are years old (with the District of 

Columbia having a suit that started in 1974, 

and Arizona and West Virginia having suits 

from 1981). Often the consent decrees and/or 

court-ordered settlements will impact the 

services and priorities of SMHAs.
24 Funding and Characteristics of State Mental Health Agencies, 2007

Table 4: Number of Mental Health Organizations Operated or Funded by SMHAs, 2007

State 

Psychiatric 

Hospitals

Community 

Mental Health 

Providers

Private 

Psychiatric 

Hospitals

General 

Hospitals With 

Separate 

Psych Units

Nursing Homes 

and Other ICFMI* and SNF** 

Providers

Total Mental 

Health 

Providers

State-operated 210 338 4 17 569

State-funded 15 10,641 98 273 85 11,112

Total 225 10,979 98 277 102 11,681

*ICF-MI = Intermediate-care facility, mentally ill

**SNF = Skilled nursing facility

Table 5: Examples of SMHA Initiatives to Integrate Private and Public Mental Health Providers

 State Initiative

AL As part of acute care planning process, private providers are developing partnerships by mental health centers related 

to local inpatient and other crisis intervention capacity.

CT (1) Continued/expanded purchase of acute care beds in general hospitals; (2) Alternative to Hospitalization (ATH) 

program to divert people in emergency departments of general hospitals to addiction services when appropriate.

GA The SMHA has contracted with private psychiatric hospitals for adult "spillover" capacity. RFPs have been released for 

private hospitals to serve both children/adolescents and adult consumers.

ID Private ACT Teams. Use private hospitals to supplement public hospitals. Contract for peer support specialist on ACT 

teams.

IL

Do have purchase of service (beds) contracts with private community hospitals to supplement state-operated bed 

need and utilization. (1) Evaluating protocols to standardize medical clearance screenings. (2) Investigating alternative 

service delivery options within emergency departments (consumer/peer services) as well as alternative site programs 

to defer crisis nonemergency cases. Investigating (1) expansion of capacity for crisis residential services; (2) adding 

capacity of subacute substance abuse programs; (3) alternative site peer-run programs like the Living Room model.

KY Several community providers are developing agreements with local private hospitals with psychiatric beds to better 

serve rural populations with limited access to the state hospitals.

NJ

Initiating a central admissions intake to better manage alternative mental health and community-based resources 

while expediting appropriate admissions to the state psychiatric hospitals; initiating greater cooperation with specialty 

population providers such as Division of Developmental Disabilities, MICA (Mental Illness and Chemical Abuse 

Addiction), and Corrections.
IV. Characteristics of 

Persons Served by 

SMHAs, FY 2007

Funding and Characteristics of State Mental Health Agencies, 2007 25

This section summarizes the characteristics of the more than 6 million 

people served by SMHAs. Consumer data are presented by age, 

gender, race/ethnicity, diagnosis, employment status, Medicaid status, 

and living situation. Information is also provided about the utilization rates 

of persons served in community settings and state psychiatric hospitals.

In 2007, 6,121,641 persons (just over 2 

percent of the U.S. population) were served 

by the 50 states, the District of Columbia, 

and 7 territories. 

The total number of persons served by 

each state ranged from a low of 9,756 in 

Delaware to a high of 658,314 in California. 

Slightly under half (48 percent) of persons 

served were male (with a utilization rate of 

19.7 per 1,000 population), and 51 percent 

were female (with a utilization rate of 20.3 

per 1,000 population). Of all the SMHAs 

reporting data, New Jersey had the highest 

utilization rate (4,027 per 100,000), while 

Massachusetts had the lowest rate (424 per 

100,000). 

4.1 Persons Served by Age and 

Gender 

Adults aged 21–64 made up the majority 

(63 percent) of the total number of persons 

served. Children (0–12) represented 14 

percent, while young adults (18–20) were 4 

percent of the persons served. Older adults 

aged 65–74 and 75 and over made up only 3 

percent, and 2 percent, respectively, of the 

total. See Figure 3 for the percentage 

distribution of persons served by age group.

Figure 3: Percentage of Consumers Served by 

Age

Text description of this graphic available 

at: http://www.mentalhealth.samhsa.

gov/cmhs/MentalHealthStatistics/

Figure3.html
26 Funding and Characteristics of State Mental Health Agencies, 2007

4.1.1 Children and Adolescents

Children (0–12 years) and adolescents 

(13–17) had an average utilization rate of 

27.3 per 1,000. Although adolescents (13–17) 

accounted for only 13 percent of the total 

number of persons served, they had the 

highest utilization rate (37.7 per 1,000) of all 

age groups. Male adolescent consumers 

(13–17) had higher rates (40.5 per 1,000) 

compared to females (34.3 per 1,000). 

Children (0–12) had a utilization rate of 

16.9, with higher male utilization rate (21.0 

per 1,000) than females (12.4 per 1,000).

4.1.2 Adults

Adults (18–64) had an average utilization 

rate of 21.9 per 1,000. Young adults (18–20) 

had an average utilization rate of 21.8 per 

1,000, with no significant difference between 

male and female consumers. Adults (21–64) 

had higher utilization rates for female 

consumers (24.2 per 1,000) compared to 

male consumers (19.5 per 1,000). 

4.1.3 Older Adults

Older adults (65 and above) had an 

average utilization rate of 7.5 per 1,000. 

Older adults in the 65–74 age range had an 

average utilization rate of 8.9 per 1,000, with 

slightly higher rates for females (10.7 per 

1,000) than males (6.8 per 1,000). Older 

adults aged 75 and over had an average 

utilization rate of 6.1, with nearly equal rates 

among male (4.8 per 1,000) and female (6.9 

per 1,000) consumers. Figure 4 shows that 

adolescents (13–17) were served at the 

highest rates for both males and females. 

Rates for male consumers were lower than 

female rates in older age groups compared to 

children’s rates, where females were served at 

higher rates than males.

4.2 Persons Served by Race and 

Gender 

4.2.1 Children and Adolescents

Children and adolescents (aged 0–17) 

accounted for 28 percent of the total number 

Figure 4: Utilization Rates of Persons Served by Age and Gender (Rate per 1,000)

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure4.html
Funding and Characteristics of State Mental Health Agencies, 2007 27

of consumers served. African American 

children had the highest utilization rate (39.6 

per 1,000). African American adolescents 

(13–17) had a higher average utilization rate 

(54.5 per 1,000), of which male children had 

a higher utilization rate (63.3 per 1,000) 

than females (45.4 per 1,000). American 

Indian/Alaska Native adolescents (13–17) 

also had higher utilization rates (50.2 per 

1,000), where males had a slightly higher 

utilization rate (52.6 per 1,000) than females 

(47.6 per 1,000). The lowest utilization rate 

in children was reported by Asian 

Americans, with an average utilization rate 

of 6.3 per 1,000 population. Figure 5 shows 

the average utilization rates of children by 

race and gender. As depicted, male 

consumers had higher utilization rates across 

all ethnic groups.

4.2.2 Adults

Adults (18–64) made up 68 percent of the 

total number of consumers served by the 

SMHAs. Similar to the children’s rates, 

African American adults had the highest 

utilization rate (31.1 per 1,000). Adults in the 

21–64 age group had a higher utilization rate 

(34.3 per 1,000), with male African 

American adults having a slightly higher 

utilization rate (34.8 per 1,000) than females 

(33.9 per 1,000). Adult Native Hawaiians/

Pacific Islanders (aged 18–64) also had 

higher utilization rates (29.5 per 1,000), with 

no significant differences in the utilization 

rates by gender (males 29.2 per 1,000; 

females 29.8 per 1,000). Adult Asian 

Americans had the lowest utilization rate 

(6.5 per 1,000 population). Figure 6 shows 

the average utilization rates of adults by race 

and gender.

4.2.3 Older Adults

Older adults (65 and above) represented 

only 5 percent of the consumers served by 

SMHAs. Native Hawaiian/Pacific Islanders 

had the highest utilization rates (16.8 per 

Figure 5: Utilization Rates of Children (0–17) by Race and Gender (Rate per 1,000)

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure5.html
28 Funding and Characteristics of State Mental Health Agencies, 2007

Figure 6: Utilization Rates of Adults (18–64) by Race and Gender (Rate per 1,000)

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure6.html

1,000 population). Consumers in the 65–74 

age group had a higher utilization rate (18.8 

per 1,000), with females having higher rates 

(20.6 per 1,000) than male consumers (16.4 

per 1,000). Consumers who were 75 and 

over did not have any significant difference 

by gender, where females had a utilization 

rate of 14.7 per 1,000, and males had a 

utilization rate of 15.0 per 1,000. Asian 

Americans had the lowest utilization rate, 

with an average of 4.7 per 1,000 population. 

Figure 7 shows the average utilization rates 

of older adults by race and gender. 

4.3 Adults (SMI) and Children (SED)

Served by SMHAs

Fifty-seven states reported demographic 

characteristics (age, gender, and race) of 

adults and children with SMI/SED served by 

the state mental health authority. The data 

are reported by age groups, gender, and race/

ethnicity. In 2007, 65.8 percent of adults and 

65.2 percent of all the children served by 

SMHAs had a diagnosis of SMI/SED. States 

varied significantly in the percentage of SMI/

SED population served for both adults (SMI) 

and children (SED). Seven states served only 

the consumers that met their definition of a 

SMI/SED diagnosis (both adults and 

children).

4.3.1 Children (SED)

African American adolescents (13–17) had 

the highest utilization rate among all age 

groups (38.1 per 1,000), with higher 

utilization rates for males than females 

(males 45.2 per 1,000; females 30.8 per 

1,000). Adolescents (13–17) had high 

utilization rates for the Native Hawaiian/

Pacific Islander population (25.9 per 1,000), 

with higher utilization rates for males (27.11 

per 1,000) than females (24.7 per 1,000). 

Lowest utilization rates were reported by 

Asian Americans: 2.0 per 1,000 for children 

(0–13) and 6.4 per 1,000 for adolescents 

(13–17).
Funding and Characteristics of State Mental Health Agencies, 2007 29

Figure 7: Utilization Rates of Older Adults (65 and Over) by Race and Gender (Rate per 1,000)

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure7.html

4.3.2 Adults (SMI)

African American young adults (18–20) 

had the highest utilization rate among adult 

consumers (24.3 per 1,000), with no 

significant difference between rates of males 

and females. Adults (21–64) had high 

utilization rates for Native Hawaiian/Pacific 

Islanders (23.6 per 1,000), with no 

significant difference between male and 

female consumers. Lowest utilization rates 

were reported by Asian Americans: 5.1 and 

4.1 per 1,000 for adults aged 21–64 and 

18–20, respectively. 

4.3.3 Older Adults (SMI)

Older adults (65–74) who were Native 

Hawaiians/Pacific Islanders reported the 

highest utilization rate among the older adult 

population (16.9 per 1,000), with higher 

utilization rates for males compared to 

females (males 23.3 per 1,000; females 13.6 

per 1,000). Older adults (75 and over) also 

showed higher rates for the Native Hawaiian/

Pacific Islander population (11.6 per 1,000), 

with utilization rates for males slightly higher 

than females (males 12.7 per 1,000; females 

10.9 per 1,000). The lowest utilization rate 

was reported by Asian Americans (4.3 per 

1,000 for the age group 65–74 and 2.9 per 

1,000 for ages 75 and over).

4.4 Living Situation of Mental Health 

Consumers Served

Most consumers (both children and adults) 

were living in private residences.

4.4.1 Children 

Fifty-four states and territories reported 

the living situation of child consumers. The 

majority of the children lived in private 

residences (84 percent), with the remainder 

living in a variety of settings, including foster 

homes (6 percent), residential care (2 

percent), children’s residential treatment (1.1 

percent), institutional settings (1.4 percent), 

and jail/correctional facilities (2 percent). A 
30 Funding and Characteristics of State Mental Health Agencies, 2007

very small percentage (0.4 percent) of the 

children served by the SMHAs were 

homeless or living in a shelter. 

4.4.2 Adults

Fifty-five SMHAs reported the living 

situation of adult consumers. Similar to child 

consumers, the majority of the adult 

consumers lived in private residences (79 

percent). The rest of the adult consumers 

were living in variety of settings, including 

residential care (5 percent), institutional 

settings (4 percent), jail/correctional facilities 

(2 percent), and foster homes (0.8 percent). 

About 4 percent of adult mental health 

consumers were homeless or living in 

shelters. Adults in the 18–64 age group 

represented the highest percentage of 

homeless consumers (4 percent). 

Overall, more male consumers (4 percent) 

were homeless or living in a shelter than 

female consumers (2 percent). Of the racial 

groups, more African American consumers 

(5 percent) were homeless or living in a 

shelter, while Hispanics/Latinos and Asian 

Americans had the lowest percentage of 

homeless consumers (2 percent each).

4.4.3 Employment Status

Fifty-five states and territories reported 

employment status of consumers served. 

Twenty-one percent of adult consumers were 

employed (as a percentage of those with 

known employment status). Consumers in 

the 21–64 age group had the highest 

employment percentage (22 percent) followed 

by the 18–20 age group (15 percent). 

Almost half of the SMHAs adult 

consumers (47 percent) were not in the labor 

force (i.e., not actively looking for 

employment). Seventy-one percent of older 

adults (65 and over) were not in the labor 

force, while 46 percent of young adults 

(18–20) and 44 percent of adults (21–64) 

were not in the labor force. 

Figure 8 depicts the employment status of 

consumers served in the community as a 

percentage of those employed, unemployed, 

and not in the labor force.

Figure 8: Employment Status of Adult Mental 

Health Consumers, 2007

Text description of this graphic available 

at: http://www.mentalhealth.samhsa.

gov/cmhs/MentalHealthStatistics/

Figure8.html

4.4.4 Employment Status by Diagnosis

Thirty-nine states reported the 

employment status of consumers by 

diagnosis. Consumers with deferred 

diagnosis/no diagnosis had the highest rate of 

employment (35 percent). Consumers with a 

diagnosis of schizophrenia had the lowest 

employment rates (11 percent), followed 

closely by consumers with a diagnosis of 

psychotic disorder (13 percent). Consumers 

with a diagnosis of bipolar disorder had a 

comparatively higher employment rate (21 

percent), and consumers with “other” 

diagnoses had an employment rate of 24 

percent.
Funding and Characteristics of State Mental Health Agencies, 2007 31

4.5 Adults and Children With 

Co-Occurring Mental Health/

Substance Abuse Disorders

Twenty-four percent of adults served by 

the SMHAs had a co-occurring mental 

health and substance abuse disorder (43 

states reporting). Only 6 percent of children 

served by the SMHAs had a co-occurring 

mental health and substance abuse disorder. 

4.5.1 Persons Served in Community and 

State Hospitals

The vast majority of the SMHAs’ 

consumers were served in community mental 

health programs (96 percent), and only 3 

percent received services in state hospitals, 

while 7 percent of consumers received 

inpatient services from settings other than 

state hospitals (see Figure 9). Consumers may 

be served in more than one setting during the 

year.

Male consumers had a higher utilization 

rate (0.77 per 1,000) of services provided in 

state hospitals than females (0.43 per 1,000). 

There were no gender differences in the 

utilization rates of services being provided in 

community mental health programs. 

4.6 Persons Served Through 

Medicaid and Other Funding 

Sources

Medicaid funds were used to pay for at 

least part of the services received by 57 

percent of the total consumers served; nonFigure 9: Persons Served in Community, State Hospitals, and Other Inpatient Beds

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure9.html
32 Funding and Characteristics of State Mental Health Agencies, 2007

Medicaid funding sources were used by 43 

percent of consumers (see Figure 10).

Services provided to 59 percent of all 

female consumers and 56 percent of male 

consumers were paid for by Medicaid. Fortyfour percent of male consumers and 41 

percent of female consumers utilized nonMedicaid funds to pay for services they 

received.

With regard to funding sources of services 

received by race, African Americans and 

multiracial consumers had the highest 

utilization of Medicaid funds, with 64 

percent each. White consumers, by 

comparison, had the lowest percentage, with 

only 55 percent utilizing Medicaid as a 

funding source (see Figure 11).

Figure 10: Persons Served by Medicaid and 

Other Funding Sources

Text description of this graphic available 

at: http://www.mentalhealth.samhsa.

gov/cmhs/MentalHealthStatistics/

Figure10.html

Figure 11: Persons Served by Medicaid and Other Funding Sources by Race

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure11.html
Funding and Characteristics of State Mental Health Agencies, 2007 33

V. SMHAs’ Responsibilities 

for Community Mental 

Health Services

and 

This section discusses the SMHAs’ responsibilities for community 

mental health services. The discussion includes the role of county/

city government in the delivery of community mental health services 

the types of community mental health services offered.

In 2007, 96 percent (5.5 million persons 

with 49 states, the District of Columbia, and 

4 territories reporting) of mental health 

consumers served by SMHA systems received 

community mental health services. Some 

individuals who received community mental 

health services also received care in state 

psychiatric hospitals (3 percent) or other 

psychiatric inpatient settings (7 percent) 

during the year, but the vast majority were 

served only in community settings. 

In 2005, SMHAs expended over 70 

percent of their funds ($20.7 billion) for 

mental health services provided in 

communities. SMHAs used three primary 

methods to pay for or deliver communitybased mental health services, with several 

states using combinations of these methods:

■■ SMHAs directly contract with local 

(usually not-for-profit) community-based 

mental health providers. This method is 

used in 36 states and is the primary 

method of funding community services in 

27 states. 

■■ SMHAs fund local government (city, 

county, or multicounty) mental health 

authorities, which in turn operate and 

contract for community mental health 

services. This method is used in 20 states 

and is the primary method used in 17 

states.

■■ Mental health services are provided in 

communities by SMHAs using their own 

state employees in state-operated 

community mental health centers. This 

method is used in 12 states and is the 

primary method used in 7 states (See 

Figure 12).

In several states, a combination of these 

mechanisms is used, with the SMHA 

operating a few mental health clinics and 

funding county or private-not-for-profit 

mental health providers for most community 

mental health services. Large-population 

states tend to use local governments to 

organize the delivery of community mental 

health services (56 percent of the U.S. 

population lives in the 17 states that 
34 Funding and Characteristics of State Mental Health Agencies, 2007

Figure 12: Primary Methods SMHAs Use to Fund Community Mental Health Services

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure12.html

primarily use county/city governments to 

organize and deliver community mental 

health services), while smaller states often 

directly operate the community system with 

their own employees (see Table 6). Most 

large-population states use county and city 

governments to coordinate the delivery of 

community mental health services as a way 

of ensuring a match of mental health services 

to local needs.

5.1 Role of County/City Government

In the states that reported using county or 

city governments to provide mental health 

services, 14 states reported that counties or 

cities are used across the entire state, and in 

3 states (Arkansas, Georgia, and Kansas), 

they are used in parts of the state. In 16 

states, some counties have merged to form 

multicounty mental health authorities.

In 13 states, local governments contributed 

their own tax dollars to pay for community 

mental health services. In eight of these 

states, the local government contributions are 

required by the SMHA as a match for state 

funds. Ten states reported that local counties/

cities collect dedicated taxes for mental health 

services.

5.2 Community Mental Health 

Providers

In 2007, SMHAs reported they operated 

and/or funded 10,979 community mental 

health providers. Of these community 

providers, the SMHAs operated 338 

programs, and an additional 10,641 
Funding and Characteristics of State Mental Health Agencies, 2007 35

7

Table 6: Primary Methods Used by SMHAs to Fund Community Mental Health Services, 2007

Primary Mechanism Used by SMHAs To 

Fund Community Mental Health

Number of 

SMHAs

Average State 

Population 

(Using Method)

Percent of U.S. 

Population

SMHA directly contracts with local providers 27 4,133,742 37%

SMHA funds local government (county/city) mental health 

authorities 17 9,802,368 56%

SMHA operates community providers with state employees 3,021,025 7%

community mental health providers were 

funded by SMHAs (see Table 4). These 

community mental health providers served 

over 5.5 million consumers. 

5.2.1 Community Providers Given Control 

Over Utilization or Budgets of State 

Psychiatric Hospitals

Over half the reporting states (24 of 47) 

are undertaking initiatives to restructure 

their community mental health system. In 

nine states, community mental health 

programs are being given control over the 

utilization or budgets of state psychiatric 

hospitals. In five states, community providers 

receive financial incentives for reducing state 

hospital utilization.

5.2.2 Community Providers Perform 

Gatekeeping Entry Into State 

Psychiatric Hospitals

In 38 states (81 percent of reporting 

states), community-based programs perform 

a gatekeeping function over entry to state 

psychiatric hospitals. The most common 

approaches to gatekeeping entry to state 

psychiatric hospitals are depicted in Table 7. 

Community providers are given this 

authority by state statute (20 states), SMHA 

regulations (11 states), or SMHA policy (21 

states). In 18 states, the state has established 

mechanisms other than community mental 

health programs or the courts to control 

admissions to state psychiatric hospitals.

Table 7: Methods of Gatekeeping That Control 

Entry to and Discharge From State Psychiatric 

Hospitals

Methods Voluntary 

Clients

Involuntary 

Clients

Preadmission screening 35 40

Hospital/community 

activities

liaison 33 38

Predischarge planning 34 39

5.3 Types of Community Mental 

Health Services Offered

In 82 percent of the SMHAs (37 of 45 

states), the SMHA required state-funded 

mental health service providers to offer a 

mandated set of mental health services. As 

shown in Table 8, case management and 

emergency services were the most commonly 

provided community-based services, which 

were offered by every reporting state for 

adult consumers. 

For children and adolescents, case 

management, school-based services, 

outpatient services, and emergency services 

were the most frequently provided services. 

Psychosocial rehabilitation, consumer-run 

services, housing, and employment services 
36 Funding and Characteristics of State Mental Health Agencies, 2007

were much less commonly provided for 

children and adolescents, while specialized 

services such as in-home family services and 

family preservation/family psychoeducation 

services were much more common.

For persons who enter the SMHA system 

through the criminal justice system 

(forensics), the most commonly offered 

services are services to courts, case 

management, and outpatient services. For 

persons who are homeless and have a mental 

illness, many states target specific services to 

meet their needs and engage them into 

services. The most common services are case 

management, housing, and emergency 

services (see Table 8).

5.4 Consumer-Operated Services

As Table 8 shows, many SMHAs are using 

consumer-operated mental health services as 

part of their continuum of mental health 

services. SMHAs most frequently support 

consumer-operated services via direct 

funding from the SMHA (42 states), 

technical assistance (37 states), conference 

sponsorships (37 states), and providing office 

space (15 states). 

SMHAs reported they provided a total of 

$62,003,065 (29 states reporting) for 

consumer-operated services. The median 

state spending for such services was 

$360,514, ranging from a high of 

$23,000,000 in Michigan to a low of $5,000 

in South Dakota. 

SMHAs reported they funded 327 

consumer-operated programs (32 states), 

with a median of 5 consumer-operated 

programs in a state, and a range from a high 

of 50 programs in Michigan to a low of 1 

program (in 6 states).

Table 8: Community-Based Services Targeted Toward Specific Population Groups

Community-Based Services Children/ 

Adolescent Adults Elderly MI Forensic MI Homeless

Case management 41 44 34 27 36

Emergency 39 44 36 24 33

Dual diagnosis: MI/SA 32 42 23 19 26

Psychosocial rehabilitation 19 42 22 15 23

Outpatient 40 41 35 25 32

Housing 9 40 22 17 35

Acute care inpatient 32 38 26 20 20

Supportive employment 6 38 9 12 18

Consumer-run services 7 38 12 0 15

PACT/ACT 7 38 17 15 21

Employment/vocational rehabilitation 12 36 11 14 21

Residential 30 34 19 15 20

MI deaf and hearing-impaired services 24 32 20 10 10

Intensive case management 28 31 22 18 25

Dual diagnosis: MI/DD 25 27 15 12 10

Services to courts 23 27 14 29 17

Extended care inpatient 20 24 20 18 14

Partial day 23 24 15 8 12

Social clubs 3 19 9 5 10

Family preservation/family psychoed 35 17 8 3 3

In-home family services 40 13 10 2 2

School-based services 42 4 2 0 1

Other services 6 4 0 0 0
Funding and Characteristics of State Mental Health Agencies, 2007 37

5.4.1 Types of Consumer-Operated Services

As Table 9 shows, SMHAs fund a variety 

of consumer-operated program activities. 

The most commonly funded activities are 

peer/mutual support, advocacy, leadership 

training, drop-in centers, and promoting 

positive public attitudes.

Table 9: Types of Consumer-Operated Services 

Funded by the SMHA

Services Number of 

States

Peer/mutual support 46

Advocacy 40

Leadership skills training 35

Drop-in centers 32

Promoting positive public attitudes 32

Wellness/prevention services 28

Technical assistance 23

Policy development 22

Social services (e.g., independent living skills, 

training, job development) 17

Vocational rehabilitation/employment 16

Client-staffed businesses 13

Research activities 10

Nonresidential crisis interventions 8

Transitional/supported housing 8

Case management 7

Residential crisis facility 4

Other 7

In 28 states, the SMHA employs or 

requires contracted providers to employ selfidentified consumers to provide peer services 

to consumers. Services provided by selfidentified consumers are presented in Table 

10. 

5.4.2 States Reimbursing Peer Specialists 

for Providing Mental Health Services 

Through Medicaid

Peer specialists are a recent advance in 

using mental health consumers to provide 

peer services that Medicaid reimburses. 

Georgia was one of the leaders in 

establishing a training program to train and 

certify mental health consumers as peer 

specialists whose services are reimbursed by 

Medicaid. This model has been viewed as 

successful in many states, and 21 states 

report they now reimburse adult consumer 

peer specialists through Medicaid. 

Additionally, the District of Columbia and 

Michigan now also reimburse adolescent 

consumer peer specialists through Medicaid.

5.4.3 Office of Consumer Affairs

In 32 states, the SMHA has an office of 

consumer or recipient affairs. Most offices of 

consumer affairs are staffed with a current 

or former recipient of public mental health 

services responsible for ensuring that mental 

health consumers are represented throughout 

the SMHA system.

5.4.4 Managed Care Practices 

The managed care practices of the SMHA 

include contracting with managed care 

organizations (MCOs), administrative service 

organizations (ASOs), and health 

management organizations (HMOs). This 

contracting happens regardless of whether a 

state has a Medicaid waiver for the provision 

of mental health or behavioral health 

services.

5.4.5 SMHA Use of Managed Care

Managed care is commonly used by states 

to provide behavioral health services. Most 

states (33) use managed care practice to 

provide mental health services. Of these, 27 

are also providing substance abuse services 

via managed care. No behavioral health 

services are being provided via managed care 

in 16 states. In Idaho, substance abuse 

services and not mental health services are 

being provided via managed care. In 2007, 

SMHAs provided mental and behavioral 

health services to 2,161,523 individuals, or 
Table 10: Services Provided by Self-Identified 

Consumers

Services Number of 

States

Consumers as providers in community mental 

health programs 26

State, regional, or local consumer-run 

organizations 22

Consumer-operated service programs 20

Support groups 18

Training and educational opportunities 15

Consumers as providers at state hospitals 14

10 percent of the 22,270,438 individuals 

covered by managed behavioral health plans.

Of the 33 states using managed care for 

mental health services, 18 have a Medicaid 

1915(b) waiver, 10 have a Medicaid Research 

and Demonstration (1115) waiver, and 5 

38 Funding and Characteristics of State Mental Health Agencies, 2007

have a Medicaid Home and CommunityBased waiver (see Figure 13 for types of 

waivers used in each State). 

Medicaid 1915(b) waivers allow states to 

provide a continuum of services to older 

adults and individuals with disabilities, such 

as nontraditional home and communitybased services. Medicaid 1115 waivers allow 

states to undertake new experimental and 

demonstration projects to test their efficacy. 

These projects often provide services that 

were not otherwise covered or provide 

innovative services. Medicaid Home and 

Community-Based waivers allow states to 

offer traditional medical services and 

nonmedical services. These services are 

Figure 13: Medicaid-Managed Care Waivers Used for Mental Health

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure13.html
Funding and Characteristics of State Mental Health Agencies, 2007 39

sometimes provided by unpaid family 

members. There were 12 states with 

approved applications for 1115 waivers and 3 

with prepared or pending applications. There 

were 17 states with approved applications for 

1915(b) waivers and 2 with prepared or 

pending applications.

Some states are using state funds to 

implement managed care practices. These 

include:

■ Colorado: Colorado Alcohol and Drug 

Abuse Division (the state substance abuse 

authority) uses a managed care delivery 

mechanism.

■ Connecticut: Contracting with an ASO; 

also for the State Administered General 

Assistance (SAGA) for both mental health 

and substance abuse.

■ The District of Columbia: Uses managed 

care practices with its local funds

■ Georgia: State Plan Amendment

■ Hawaii: SMHA acting as prepaid inpatient 

health plan

■ Louisiana: The Office of Mental Health 

(OMH) serves as managed care agent for 

Medicaid-managed care services under the 

psychiatric rehabilitation option

■ New Jersey: Children’s mental health 

contracts with an ASO

5.4.6 Services Provided Under Managed 

Care Plans

The types and number of services 

provided by managed care plans vary by 

state and by waiver (see Figure 13 for types 

of waivers used in each state). The services 

most often cited by states with managed care 

waivers were the assessment and diagnosis of 

clients, emergency/crisis services, and 

treatment planning (see Table 11). 

Most states (28) carve mental health 

benefits out of the basic benefit plan to 

specialty behavioral healthcare networks or 

managed behavioral health organizations. 

Some states (11) carve in mental health 

benefits, with general health benefits 

provided by primary healthcare providers or 

HMOs.

5.4.7 Medicaid Options Adopted by the State 

Medicaid Plan for Covering Mental 

Health Services

States are allowed to adopt a variety of 

Medicaid options for covering mental health 

services under their Medicaid plan. With the 

exception of Tennessee, all states, including 

the District of Columbia, have adopted the 

Table 11: Services Provided via Managed Care 

Plans

Services Provided Under Managed Care 

Plans

Number of 

States

Assessment and diagnosis 32

Outpatient therapy 30

Emergency/crisis 28

Treatment planning 28

Acute hospitalization 27

Day treatment/partial hospitalization 25

Psychosocial rehabilitation 23

Intensive in-home services 23

Prescription drugs for mental health 20

Services in residential treatment centers 19

Wraparound services (e.g., intensive case 

management, supported employment, respite 

services)

16

Crisis residential services 15

Peer support 14

Long-term hospitalization 11

Consumer-run services 7

rehabilitation option. Most states have 

adopted the under age 21 inpatient (41 

states), the over age 65 inpatient (35), 

targeted case management (31), and the clinic 

(30) options. Few states have adopted the 
40 Funding and Characteristics of State Mental Health Agencies, 2007

personal care option (12). Other options that 

states have adopted include: Capitol Waiver; 

rehabilitation option for mental health group 

homes, and under 21, residential treatment; 

emergency mobile psychiatric and home-base 

services’ EPSDT; 1115 waiver that includes 

clinic and rehabilitation options and no age 

limit for eligible populations; general acute 

inpatient care; counseling from licensed 

professionals (LPC, LMFT, advanced clinical 

social worker, psychologist, psychiatrist); 

crisis intervention services; and partial-day 

hospital (adult day treatment). 
Funding and Characteristics of State Mental Health Agencies, 2007 41

VI. SMHA Psychiatric 

Inpatient Systems, 

Acute Care Issues, 

and Forensic Services

All SMHAs operate state psychiatric inpatient beds, and many 

states are currently engaged in initiatives to reconfigure their 

state psychiatric inpatient system and how it relates to the needs 

for acute psychiatric treatment. Increasingly, state psychiatric hospitals are 

devoting resources to providing forensic mental health services.

6.1 State Psychiatric Hospitals

Every SMHA operates psychiatric 

inpatient beds that provide care and 

treatment to individuals with high levels of 

need and who are at risk to themselves or 

others because of their mental illnesses. 

These state psychiatric hospitals served 

approximately 175,583 persons during 2007 

(3 percent of all mental health consumers 

served by SMHA systems during the course 

of 2007) and had expenditures of $8 billion 

(27 percent of total SMHA expenditures).

Forty-nine states and the District of 

Columbia operate a total of 232 state 

psychiatric hospitals—hospitals that are 

operated and staffed by the SMHA that 

provides specialized inpatient psychiatric 

care. Rhode Island is the only state that does 

not have a stand-alone state psychiatric 

hospital; however, Rhode Island does have a 

state-operated general hospital that has 

psychiatric inpatient beds. In over half the 

states (26), there are 3 or fewer state 

psychiatric hospitals. As the map below 

shows, the 13 states that have only 1 state 

psychiatric hospital tend to be in the 

mountain-frontier west and New England. 

The 11 states that have 6 or more state 

psychiatric hospitals are all larger-population 

states and are mostly in the east and 

southern regions of the country (See Figure 

14 and Table 13).

At the end of 2006, there were 43,601 

patients residing in these state psychiatric 

hospitals. States varied widely in the number 

of inpatients they had, ranging from 66 in 

Alaska to 6,327 in California. The median 

number of state psychiatric hospital residents 

was 655. On average, states had 14.5 state 

psychiatric residents per 100,000 population 

(the median was 13.7). The range was from a 

low of 3.5 in New Mexico to a high of 41.0 

in North Dakota (see Figure 15).
Figure 14: Number of State Psychiatric Hospitals

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure14.html

Figure 15: State Psychiatric Hospital Residents per 100,000 Population

42 Funding and Characteristics of State Mental Health Agencies, 2007

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure15.html
Funding and Characteristics of State Mental Health Agencies, 2007 43

6.2 State Psychiatric Hospital 

Reorganization

Even prior to the 1963 Community 

Mental Health Centers Act, which 

established a goal of having a nationwide 

network of community mental health centers, 

states were under pressure to reduce the size 

of state psychiatric hospitals. One of the 

goals of the Federal Community Mental 

Health Services Block Grant is to help states 

minimize their use of state psychiatric 

inpatient beds. As a result of these policies, 

there were many fewer state hospitals in 

2007 than before, and many fewer patients 

in them. 

Over the past half century, the National 

Institute of Mental Health, CMHS, and the 

states have documented a historic shift in the 

size, nature, and usage of state psychiatric 

hospitals. According to CMHS, in 1950, 

there were 512,501 patients in state and 

county psychiatric hospitals. By 2005, that 

number had declined by 90 percent to only 

49,947 patients (see Table 12). Over that time 

period, the number of state psychiatric 

hospitals had also declined by 37 percent 

(note that the CMHS count of the number of 

state psychiatric hospitals in 2005 is lower 

than the number of state psychiatric hospitals 

reported to the NRI SPS by SMHAs).

The number of deaths that occurred in 

state psychiatric hospitals shows a major 

decline from the 1950s through 1990, when 

CMHS ceased collecting that information. 

The state psychiatric hospitals of the 1950s 

and 1960s were much more focused on longterm care, with many patients remaining in 

the hospital for years. State psychiatric 

hospitals at the middle of the century had 

large numbers of older adults who had been 

at the hospitals for years and who may have 

had physical illnesses along with mental 

illnesses. At the current time, state 

psychiatric hospitals are much smaller but 

also have much shorter lengths of stay. 

As a result of the major decrease in the 

number and size of state psychiatric 

hospitals, many states are reorganizing their 

state psychiatric hospital systems. In 2007, 

just over half of the states (54 percent) 

reported they were involved in some aspect 

of reorganization of their state psychiatric 

hospital system. As Figure 16 shows, the 

most frequently cited reorganization activities 

Table 12: Number of Resident Patients, Total Admissions, Net Releases, and Deaths: State and 

County Psychiatric Hospitals, 1950–2005

Year Number of 

Hospitals

Residents at 

End of Year Admissions Net Releases Additions Deaths

1950 322 512,501 152,286 99,659 41,280

1955 275 558,922 178,003 126,498 44,384

1960 280 535,540 234,791 192,818 49,748

1965 290 475,202 316,664 288,397 43,964

1970 315 337,619 384,511 386,937 30,804

1975 313 193,436 376,156 384,520 433,529 13,401

1980 276 132,164 NA NA 370,344 6,800

1985 279 116,136 NA NA 332,229 4,898

1990 281 92,059 NA NA 277,813 2,321

1995 258 69,177 NA NA 220,350 NA

2000 230 54,836 NA NA 158,034 NA

2005 204 49,947 NA NA 188,649 NA
44 Funding and Characteristics of State Mental Health Agencies, 2007

Figure 16: State Psychiatric Hospital Reorganization Activities, 2007

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure16.html

6.3.1 Construction of State Psychiatric 

Hospitals 

include closing hospital wards (25 percent) 

and replacing an old hospital with a new 

hospital (23 percent). An equal number of 

states (17 percent) were downsizing one or 

more state hospitals or were increasing the 

size of one or more state hospitals.

6.3 Closing State Psychiatric 

Hospitals

Over the last 55 years, there has been a 

reported net decrease of 118 state psychiatric 

hospitals (over this time, some states have 

opened new hospitals). In 2007, five states 

reported they had closed a total of seven 

state hospitals over the last 2 years, and three 

states reported they were currently planning 

to close a state psychiatric hospital. Five 

states reported they were working on plans 

to close an additional six state psychiatric 

hospital in the next 2 years. The data show 

that although many of the state hospital beds 

were closed during the 1950s to 1970s, the 

majority of state psychiatric hospitals have 

been closed since 1990.

As Figure 16 on hospital reorganization 

demonstrates, states are no longer just 

closing state psychiatric hospitals. In 11 

states, the SMHA is involved in replacing an 

old state psychiatric hospital with a new 

hospital. SMHAs often report that the cost 

savings from reduced maintenance and 

heating/cooling costs of a new modern 

building can help pay for the old building. 

Five states (California, the District of 

Columbia, Massachusetts, New Jersey, and 

Nevada) reported they are building or 

recently opened brand-new state psychiatric 

hospitals (not replacement hospitals). In 

California, the new psychiatric hospital 

represents a specialized program for sex 

offenders. In Nevada, the Rawson-Neal 

Psychiatric Hospital was built in the Las 

Vegas area in response to increased need 

resulting from the tremendous growth in 

population in that region of the state. North 

Carolina is building a new psychiatric central 
Funding and Characteristics of State Mental Health Agencies, 2007 45

Table 13: State Psychiatric Hospitals

State

Number of 

State 

Hospitals 

(2007)

Number of 

Residents (Last 

Day of Year)

Population 

Estimate July 1, 

2007

Residents per 

100,000 

Population

2006 Percentage 

of Adults Who 

Were Forensic 

Status

Percentage of 

Adults 

Discharged in 30 

Days or Less

Alaska 1 66 683,478 9.7 6% 92%

Alabama 6 1,210 4,627,851 26.1 17% 33%

Arkansas 1 201 2,834,797 7.1 52%

Arizona1 1 6,338,755

California 5 6,327 36,553,215 17.3 82% 20%

Colorado2 2 519 4,861,515 10.7 75%

Connecticut 4 623 3,502,309 17.8 34% 23%

District of Columbia2 1 588,292 28%

Delaware 1 242 864,764 28.0 32% 79%

Florida 7 2,559 18,251,243 14.0 39% 1%

Georgia 7 1,188 9,544,750 12.4 91%

Hawaii1 2 1,283,388 83%

Iowa 4 134 2,988,046 4.5 2%

Idaho1 2 1,499,402

Illinois 10 1,145 12,852,548 8.9 10%

Indiana 6 1,109 6,345,289 17.5 16% 7%

Kansas 3 634 2,775,997 22.8

Kentucky 4 490 4,241,474 11.6 3% 87%

Louisiana 5 867 4,293,204 20.2 13% 86%

Massachusetts 10 869 6,449,755 13.5 33% 45%

Maryland 10 1,192 5,618,344 21.2 50% 53%

Maine 2 86 1,317,207 6.5 46%

Michigan 6 803 10,071,822 8.0 21%

Minnesota 11 396 5,197,621 7.6 39%

Missouri 11 1,363 5,878,415 23.2 39% 86%

Mississippi2 4 2,918,785

Montana 1 209 957,861 21.8 38%

North Carolina 4 1,080 9,061,032 11.9 2% 89%

North Dakota 1 262 639,715 41.0 55% 64%

Nebraska2 3 1,774,571

New Hampshire 1 177 1,315,828 13.5 75%

New Jersey 5 2,233 8,685,920 25.7 8% 24%

New Mexico 1 69 1,969,915 3.5 52% 71%

Nevada 2 185 2,565,382 7.2 26% 75%

New York 27 5,199 19,297,729 26.9 19% 18%

Ohio 5 1,044 11,466,917 9.1 20% 70%

Oklahoma 4 311 3,617,316 8.6 54% 81%

Oregon 2 721 3,747,455 19.2 65% 13%

Pennsylvania 8 1,932 12,432,792 15.5 41% 4%

Rhode Island3 0 150 1,057,832 14.2 3%

South Carolina 3 676 4,407,709 15.3 40% 67%

South Dakota 1 254 796,214 31.9 4% 77%

Tennessee 5 809 6,156,719 13.1 26% 93%

Texas 12 2,409 23,904,380 10.1 29% 62%

Utah 1 335 2,645,330 12.7 30% 24%

Virginia 11 1,544 7,712,091 20.0 39% 54%

Vermont 1 216 621,254 34.8 52%

Washington 3 1,290 6,468,424 19.9 30% 32%

Wisconsin 3 473 5,601,640 8.4 59% 70%

West Virginia 2 1,812,035 26%

Wyoming 1 69 522,830 13.2 5% 60%

Total 232 43,601 301,098,327 14.5 60%

Average 5 993 5,914,140 16.8 32% 52%

Median 3 655 4,241,474 13.7 30% 54%

Minimum 0 66 522,830 3.5 2% 1%

Maximum 27 6,327 36,553,215 41.0 83% 93%

Source: 2007 SMHA Profiles, unless noted below

1 = 2006 NRI State Profiles

2 = 2005 CMHS Annual Census Data

3 = Rhode Island does not have a state psychiatric hospital; has psychiatric beds in a state-operated general 

hospital
46 Funding and Characteristics of State Mental Health Agencies, 2007

regional hospital that will take the place of 

two existing state hospitals.

6.3.2 How SMHAs Use State Psychiatric 

Hospitals

There are variations in how SMHAs use 

their state psychiatric hospitals to provide 

services to persons with mental illnesses. A 

few states have focused their state psychiatric 

hospitals on providing acute short-term 

(length of stay of 30 days or less) inpatient 

care, while other states have focused on 

providing only long-term inpatient 

psychiatric treatment. Table 14 shows how 

SMHAs report use of their state psychiatric 

hospitals for different age groups.

All SMHAs have inpatient psychiatric 

beds for treating adult mental health 

consumers. In three states, state psychiatric 

hospitals are focused on providing acute or 

intermediate-length inpatient services (less 

than 90 days) to adults. As Table 13 shows, 

over half of all patients discharged from state 

hospitals had a length of stay of 30 days or 

less. In a few states (Arkansas, Georgia, and 

Tennessee), over 90 percent of discharged 

patients had a length of stay of 30 days or 

less. Other states had very few clients 

discharged so quickly (Florida, Indiana, 

Pennsylvania, and Rhode Island had under 

10 percent of clients discharged in 30 days or 

less).

Some states dedicate their state psychiatric 

inpatient beds for adults and forensic clients 

and do not have inpatient beds for children. 

There were 32 states that reported they focus 

state hospitals on serving children and 

adolescents in state psychiatric hospitals, and 

12 of these SMHAs focus on acute/ 

intermediate length of stays for children and 

adolescents.

6.3.3 Use of Non-SMHA General Hospitals 

and Other Local Hospitals

In several states, the SMHA has developed 

a policy to use local hospitals to provide 

inpatient psychiatric treatment as an initial 

admission site prior to using state psychiatric 

hospitals. Under these policies, persons in 

need of inpatient psychiatric services first use 

local hospital beds and only go on to the 

state psychiatric hospital if they need 

additional inpatients services. These policies 

are more frequently in place for adults, where 

35 percent of the states (18 states) reported 

having such a policy in place. Nine states 

reported having a policy to use local 

hospitals as an initial admission site for 

children and adolescents. 

6.4 Psychiatric Acute Care 

Shortages

As the previous section demonstrated, 

state psychiatric hospitals have undergone a 

tremendous downsizing over the last 50 

years. However, state psychiatric hospitals 

are not the only type of psychiatric beds that 

have declined in numbers over time. CMHS 

Table 14: Number of States Using State Psychiatric Hospitals by Age and Service

Acute Inpatient Intermediate Inpatient Long-Term Inpatient 

Population

(Less than 30 days) (30–90 days) (More Than 90 days)

Number of 

States Percent Number of 

States Percent Number of 

States Percent

Children 23 47% 20 41% 15 31%

Adolescents 29 59% 26 53% 20 41%

Adults 41 84% 43 88% 43 88%

Elderly 37 76% 40 82% 40 82%

Forensic 36 73% 41 84% 43 88%
Funding and Characteristics of State Mental Health Agencies, 2007 47

has been tracking the number of psychiatric 

facilities and beds across both public and 

private sectors, and data show a decline in 

overall state psychiatric bed capacity. In 

1970, there were over 500,000 psychiatric 

beds in the United States, but that number 

declined by 81 percent over the last 32 years. 

From 1990 to 2002, the number of dedicated 

psychiatric beds did not just decline in state 

psychiatric hospitals, but also in private 

psychiatric hospitals, Veterans Affairs 

psychiatric centers, and general hospitals, 

which all declined at least 25 percent (see 

Table 15). Only “other” mental health 

organizations and residential treatment 

centers for emotionally disturbed children 

increased their number of psychiatric beds 

over the most recent 12 years.

As Table 16 shows, when the increase of 

population in the United States is factored in, 

the number of beds per 100,000 civilian 

population has declined by 72 percent since 

1970, from 263 beds per 100,000 to 73.3 

beds per 100,000 civilian population.

The PNFC on mental health cited acute 

care as an area in need of further study and 

Table 15: Number of 24-Hour Hospital and Treatment Beds

Year State 

Hospitals

Private 

Psychiatric 

Hospitals

VA 

Psychiatric 

Services

General 

Hospitals

Other Mental 

Health 

Organizations

Residential 

Treatment 

Centers

Total 

Psychiatric 

Beds

State 

Hospitals as 

Percent of 

Total 

Psychiatric 

Beds

1970 413,066 14,295 50,688 22,394 1,198 15,129 516,770 80%

1976 222,202 16,091 35,913 28,706 993 18,029 321,934 69%

1980 156,482 17,157 33,796 29,384 1,433 20,197 258,449 61%

1986 119,033 30,201 26,874 45,808 21,150 24,547 267,613 44%

1990 98,789 44,871 21,712 53,479 23,646 29,756 272,253 36%

1998 68,872 33,408 16,973 54,434 62,144 31,965 267,796 26%

2000 60,675 26,484 9,363 39,690 43,034 33,375 212,621 29%

2002 57,263 25,095 9,672 40,202 39,918 39,049 211,199 27%

Change 1970–1990 -76% 214% -57% 139% 1874% 97% -47%

Change 1990–2002 -42% -44% -55% -25% 69% 31% -22%

Change 1970–2002 -86% 76% -81% 80% 3232% 158% -59%

Table 16: 24-Hour Hospital and Residential Treatment Beds per 100,000 Population

Year State 

Hospitals

Private 

Psychiatric 

Hospitals

VA 

Psychiatric 

Services

General 

Hospitals

Other Mental 

Health 

Organizations

Residential 

Treatment 

Centers

Total 

Psychiatric 

Beds

State 

Hospitals as 

Percent of 

Total 

Psychiatric 

Beds

1970 207.4 7.2 25.5 11.2 0.6 7.6 263.6 79%

1976 105.1 7.6 17.0 13.6 0.5 8.5 160.3 12%

1980 70.2 7.7 15.7 13.7 0.6 9.1 124.3 56%

1986 49.7 12.6 11.2 19.1 8.8 10.3 111.7 44%

1990 40.5 18.4 8.9 21.9 9.7 12.2 111.6 36%

1998 31.6 12.4 6.3 20.2 23.1 11.9 99.5 32%

2000 21.5 9.4 3.3 14.1 15.3 11.8 75.4 29%

2002 19.9 8.7 3.4 14.0 13.9 13.6 73.3 27%

Change 1970–1990 19% 156% -65% 96% 1517% 61% -58%

Change 1990–2002 -51% -53% -62% -36% 43% 11% -34%

Change 1970–2002 -90% 21% -87% 25% 2217% 79% -72%
48 Funding and Characteristics of State Mental Health Agencies, 2007

found that “shortages exist in the availability 

of psychiatric beds and other levels of acute 

care in many regions of the country” (US 

DHHS, 2003). Over the last 5 years, 64 

percent of states (29 of 45) have experienced 

declines in the number of general hospital 

specialty unit psychiatric beds, and 10 states 

have experienced a decline in the number of 

private psychiatric hospital beds. The impact 

of all these closings is that 80 percent of the 

states (39 of 49) are experiencing a shortage 

in psychiatric beds.

In 37 states, the result is a shortage of 

acute care beds, in 15 states a shortage of 

long-term care beds, and in 27 states a 

shortage of forensic beds. SMHAs report 

that the impact of these bed shortages 

include: increased waiting lists for state 

hospital beds in 27 states, increased waits for 

other psychiatric beds in 15 states, 

overcrowding in state hospitals in 19 states, 

and increased resistance to closing additional 

state hospital beds in 16 states.

In 22 states, the SMHA reported that 

consumers remain in emergency departments 

when they are ready to be discharged 

because there are no suitable placements (e.g., 

no available hospital beds and/or residential 

beds for those who need them). In 27 states, 

the SMHAs reported they are working with 

general hospital emergency departments to 

improve crisis services for individuals with 

mental illnesses.

SMHAs describe undertaking a variety of 

activities and expenditures to address these 

problems. Initiatives include increasing 

Figure 17: SMHAs Experiencing a Shortage of Psychiatric Inpatient Beds, 2007

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure17.html
Funding and Characteristics of State Mental Health Agencies, 2007 49

funding to community providers to provide 

inpatient and crisis services, increasing the 

number of ACT programs, and launching 

studies of the problem. There were 48 states 

that reported they are developing or 

supporting alternative forms of mental health 

treatment to reduce the need for these 

hospitalizations.

6.5 Forensic Mental Health Services

As discussed in Section III of this report, 

SMHAs vary widely in their responsibilities 

for providing mental health services to 

forensic clients. In recent years, increasing 

shares of state psychiatric hospital 

expenditures have been devoted to forensic 

services. In FY 2005, SMHAs expended $2.3 

billion of their state hospital expenditures on 

services for forensic status clients (30 percent 

of state hospital inpatient expenditures) and 

an additional $257 million for sex offender 

services (3.3 percent of state hospitalinpatient expenditures). SMHAs also vary in 

the amount of psychiatric hospital 

expenditures that are devoted to forensic 

status clients and sex offender services. For 

example, a few states have no forensic service 

responsibilities, while in eight states, over 

half of state hospital expenditures were for 

forensic and sex offender services. These 

eight states ranged from Vermont, where 50 

percent went to forensics, to California, 

where 87 percent of expenditures went to 

these services.

Since 1983, forensic and sex offender 

services in state psychiatric hospitals have 

increased from 7.6 percent (in FY 1983) of 

state hospital inpatient spending to 10 

percent in FY 1990 and 33 percent in FY 

2005 (see Figure 18). The growth in 

expenditures for forensic and sex offender 

services appears to be continuing as several 

states have recently expanded their sexual 

Figure 18: SMHA-Controlled Forensic and Sex Offender Mental Health Expenditures, FY 1983– 

FY 2005

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure18.html
50 Funding and Characteristics of State Mental Health Agencies, 2007

offender treatment programs in state 

psychiatric hospitals.

6.5.1 Organization of State Forensic Mental 

Health Services

Almost all SMHAs (47 out of 49 

reporting) have statutory responsibility for 

providing some mental health services to 

forensic clients. In over two-thirds (69 

percent) of the states and the District of 

Columbia (34 states), the SMHA is 

responsible for adult forensic services. In 13 

states, the SMHA shares the responsibility 

with another agency. Only in Iowa and South 

Dakota does the SMHA have no 

responsibility for adult forensic services (see 

Figure 19).

Most SMHAs play a role in administering 

court evaluation of mental health status. In 

over half (56 percent) of the states (27), the 

SMHA is responsible for court evaluations of 

mental health status. In 16 states, the 

responsibility is shared with another agency. 

In five states (Arizona, Minnesota, North 

Dakota, South Dakota, and Texas), the 

SMHA has no responsibility for court 

evaluations of mental health status. 

A majority of SMHAs play a role in 

administering services to persons with 

mental illness in prisons and jails. In five 

states (Louisiana, New York, Oregon, 

Pennsylvania, and South Dakota), the SMHA 

is responsible for services in prisons and jails. 

In 23 states, the responsibility is shared with 

another agency. In 20 states, the SMHA has 

Figure 19: SMHA Responsibility for Forensic Mental Health Services, 2007

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure19.html
Funding and Characteristics of State Mental Health Agencies, 2007 51

no responsibility for services in prisons and 

jails. 

The SMHA has a central administrative 

management unit responsible for planning, 

administration, and/or monitoring of forensic 

services in 31 states. There is a designated 

forensic director within the SMHA in 28 

states. In 12 states, forensic responsibilities 

are part of the responsibility of multiple 

individuals or are part of the responsibility of 

persons with additional responsibilities (e.g., 

hospital directors, medical directors). In 

seven states, there is no single person charged 

with responsibility for forensic services.

6.5.2 Not Guilty by Reason of Insanity and 

Guilty but Mentally Ill Statutes

Most states (48) have a Not Guilty by 

Reason of Insanity (NGRI) statute, where 

persons charged with crimes can be found 

not guilty or not criminally responsible due 

to their mental illness. Persons found NGRI 

are usually sent to a state psychiatric 

treatment facility until such time as they are 

found to be well and safe enough to be 

released to their community. Twenty-seven 

states reported a total of 852 individuals had 

been found NGRI during the last year. The 

range was from 1 person found NGRI last 

year (in several states) to a high of 107 

(Maryland). The median number of persons 

found NGRI last year was 15. At the end of 

2006, there were 4,686 adult residents in 

state psychiatric hospitals who were there 

with NGRI status (34 states reporting). The 

average number of adult residents with 

NGRI status was 138, and the median 

number of NGRI-status adult residents was 

46. The range was from 1 in several states to 

1,220 in California.

There were 14 states that have a Guilty 

but Mentally Ill (GBMI) statute, where a 

criminal defendant can be found guilty of a 

crime but also to have had a mental illness. 

There were two states with both NGRI and 

GMBI statutes (only Oregon reported having 

only a GBMI statute). A total of 170 persons 

were reported as having been found GBMI 

last year (6 states reporting), with a range 

from 1 to a high of 84. The median number 

of persons found GBMI last year was 21. At 

the end of 2006, there were 480 adult 

residents in state psychiatric hospitals who 

were there with GBMI status (4 states 

reporting). The average number of adult 

residents with GBMI status was 120, and the 

median number of GBMI-status adult 

residents was 65. The range was from 11 in 

Delaware to 340 in Oregon.

6.5.3 Scope of Forensic Mental Health 

Services

At the end of 2006, 41 states reported an 

adult forensic census of 17,660 adults in their 

state psychiatric hospitals. In 13 states, an 

additional 261 juveniles were forensic 

residents in state psychiatric hospitals. As 

Table 17 shows, among adult forensic 

patients, Incompetent To Stand Trial (30 

percent) and NGRI (27 percent) were the two 

most common forensic statuses of residents. 

Among juvenile forensic residents, the most 

common status was Pretrial Evaluations (30 

percent) and Incompetent To Stand Trial (26 

percent).

6.5.4 Sex Offenders

There are now 19 states that have laws 

providing specifically for the hospitalization/

commitment of sex offenders, including 

sexually violent predators, sexually 

dangerous persons, etc. The use of these 

sexual offender laws has increased since the 

1997 U.S. Supreme Court decision in Kansas 
Table 17: Forensic Status of State Psychiatric 

Hospital Residents

52 Funding and Characteristics of State Mental Health Agencies, 2007

Adult 

Residents

Juvenile 

Residents

Incompetent to stand trial 30% 26%

Not guilty by reason of insanity 27% 2%

Guilty, but mentally ill 3% 0%

Pretrial evaluation 4% 30%

State prisoners transferred to mental 

health 4% 10%

Jail detainees transferred to mental 

health 3% 3%

Sexual offenders committed to mental 

health 11% 0%

Other (includes status not available) 18% 30%

Total forensic residents 17,660 261

v. Hendricks, which affirmed state laws that 

allow persons completing prison sentences to 

be committed to psychiatric institutions for 

treatment if they are deemed a danger by the 

courts (US Supreme Court of the United 

States, 1997).

Since that decision, states have reported an 

increasing number of persons being 

committed to state psychiatric hospitals 

under these statutes. However, SMHAs vary 

widely regarding their responsibilities for 

providing services to sexual offenders. As 

Table 18 shows, in most states with sex 

offender statutes, the SMHA is responsible 

for administering the mental health facility 

and providing clinical services to persons 

committed under sex offender statutes. 

However, in several states, sexual offenders 

are housed in facilities administered by the 

department of corrections, with the SMHA 

providing mental health services.

In 2007, states reported an adult forensic 

census of 2,026 sexual offenders (an increase 

from 1,727 in 2005). The number of adult 

sexual offenders in SMHA psychiatric 

hospitals varied from a high of 678 in 

California to a low of 4 in the District of 

Columbia (where most sex offenders are 

served in a Federal prison). The median 

number of sexual offenders in a state with 

sex offender statutes was 142 persons.

6.5.5 Provision of Mental Health Services to 

Persons in Prison or Jails

In most states (42), the state department of 

corrections is responsible for providing 

mental health services to adults in prison. In 

seven states, the SMHA system is responsible 

for providing mental health services to adults 

Table 18: Responsibilities for Sex Offender Services

Services SMHA

Department 

of 

Corrections

SMHA With 

Corrections 

or Another 

Agency

Other Total

Screening Corrections inmates to identify candidates for 

commitment proceedings 2 11 4 9 26

Evaluating individuals whose commitment someone else 

has petitioned 10 3 2 12 27

Providing for the facility in which the committed individual 

has served 11 5 0 11 27

Providing for administration of the committed facility 13 3 0 9 25

Providing or paying for clinical services 13 3 0 9 25

Providing or paying for security services 11 5 2 9 27
Funding and Characteristics of State Mental Health Agencies, 2007 53

in prison. For juveniles who are in the state’s 

juvenile justice system, the SMHA is 

responsible for providing direct mental health 

services in only four states. In most states, 

either the state corrections agency (22 states) 

or some other agency (25 states) is 

responsible for providing mental health 

services. 

Only one state (Maine) reported that the 

SMHA has the responsibility for providing 

mental health services to persons with SMI 

in local jails or detention centers. Three 

additional states reported that the SMHA 

shares responsibility for providing these 

mental health services with the city/county 

jails. In most states, the provision of mental 

health services to persons with SMI in jails is 

the responsibility of the city/county jail or the 

sheriff’s office that administers the jail. Most 

SMHAs reported they have initiatives under 

way to work with jails to improve mental 

health services in these settings. 

The SMHA funds, operates, or provides 

community mental health programs that 

provide mental health services to:

■ Adults in local jails or detention centers in 

28 states and to juveniles in 19 states

■ Adults among the community corrections 

population (probation, parole, alternatives 

to incarceration, juvenile probation/

suspensions, etc.) in 30 states and to 

juveniles in 24 states

■ Adults in local sheriffs’ offices in 10 states 

and to juveniles in 4 states

VII. New Freedom 

Commission Activities

As described in Section I, the PNFC established six major goals for 

transforming mental health care in America. SMHAs have been 

actively working to implement changes in their system to address 

the goals laid out by the PNFC. This section summarizes some of the SMHA 

activities designed to address each of those six goals.

7.1 Goal 1: Americans Understand 

That Mental Health Is Essential 

to Overall Health

Goal 1 is subdivided as follows:

1.1 Advance and implement a national 

campaign to reduce the stigma of 

seeking care and a national strategy 

for suicide prevention.

1.2 Address mental health with the same 

urgency as physical health.

Key to the achievement of the first PNFC 

goal are activities by SMHAs and others to 

improve the public’s understanding of mental 

health and to reduce the stigma and 

discrimination related to mental illnesses. 

The SMHAs reported engaging in a wide 

variety of initiatives to achieve this goal.

7.1.1 Public Information Initiatives

Sixty-eight percent of SMHAs (34 of 50) 

reported they have public information 

initiatives to promote a better understanding 

of the role of mental health to overall health. 

Twenty-nine of these states had initiatives 

geared toward children, and 30 had 

initiatives geared towards adults. Initiatives 

in this area include radio and television 

public service announcements, billboards, 

booklets, supporting speakers, community 

forums, and other educational activities.

7.1.2 Stigma

Eighty-eight percent of the SMHAs (44 of 

50 reporting) are involved in stigma or 

discrimination reduction activities. In 30 

states, these are universal initiatives (designed 

to address all population groups), while in 37 

states, the initiatives are targeted toward 

specific population groups. The most 

common focus of these targeted antistigma 

efforts include:

■ Children/adolescents (27 states)

■ Adults (30 states)

■ Older adults (16 states)

■ Cultural and minority groups (11 states)

SMHA antistigma activities included 

working with consumer groups to combat 

stigma in five states, developing and 

supporting television announcements in five 

Funding and Characteristics of State Mental Health Agencies, 2007 55
56 Funding and Characteristics of State Mental Health Agencies, 2007

Figure 20: SMHA Has Stigma and Discrimination Initiatives 

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure20.html

New Mexico described its antistigma 

campaign as follows: 

“Citizen organizers (contract employees) are 

developing grass roots initiatives in several 

communities statewide. Most of these programs 

address stigma issues in the community. Also, 

through the Behavioral Health Purchasing 

Collaborative culturally appropriate and 

sensitive services are a priority. The New 

Mexico Behavioral Health Collaborative is in 

the process of creating a Stigma Reduction 

Campaign. Prior to the launch of the campaign 

we will conduct a baseline survey to determine 

the attitude, awareness, knowledge and 

behavior of the general public when it comes 

to mental illness and substance abuse. After 

the Stigma-Reduction campaign is rolled out 

through television and radio public service 

announcements we will go back and survey 

the general public to see if their attitudes, 

awareness and knowledge of mental illness and 

substance abuse have changed.”

states, and working with business/civic 

groups in three states. 

7.1.3 Suicide Prevention

Most SMHAs (90 percent or 45 SMHAs) 

operate or fund suicide prevention programs. 

In 42 States, the SMHA operates or funds 

suicide prevention programs targeted for 

adolescents, in 37 states targeted for adults, 

and in 32 states targeted towards older 

adults.

SMHAs in most states (80 percent) have 

developed a plan to reduce suicide attempts 

or initiate suicide prevention programs. In 38 

states, these plans are focused on 

adolescents, in 36 on children, in 36 on 

adults, and in 30 on older adults. 
Funding and Characteristics of State Mental Health Agencies, 2007 57

Thirty-one SMHAs reported they operate, 

fund, or participate in postsuicide attempt 

activities. Examples of postsuicide attempt 

activities of SMHAs include: sponsoring 

suicide survivor groups and emergency 

response teams to work with families and 

schools after suicide attempts. For example, 

Texas reported: “The SAMHSA funded 

Texas Youth Suicide Prevention grant 

provides follow-up for youth who have 

attempted suicide. Suicide prevention 

gatekeeper training is offered to the schools 

these youth attend. School staff and parents 

(PTA) are the target audience for this 

training.”

7.2 Goal 2: Mental Health Care Is 

Consumer- and Family-Driven

Goal 2 is subdivided as follows: 

2.1 Develop an individualized plan of care 

for every adult with a serious mental 

illness and child with a serious emotional 

disturbance.

Kansas reported a number of initiatives for 

PNFC Goal 1, including: 

1. Veterans and family initiatives to identify 

gaps in needed services

2. Outreach to rural and frontier areas 

3. PSA efforts to decrease stigma associated 

with seeking help in the general population 

and consumers sharing their recovery 

journey and encouraging sensitivity 

towards individuals with mental illness

4. Poster campaigns to display statistics and 

prevalence of mental illness among 

children through older adults to encourage 

help-seeking behavior

5. Producing an annual children’s calendar 

featuring children’s art from consumers of 

mental health services

6. Educational presentations at local schools 

to raise awareness of suicide prevention 

2.2 Involve consumers and families fully 

in orienting the mental health system 

toward recovery.

2.3 Align relevant Federal programs to 

improve access and accountability for 

mental health services.

2.4 Create a comprehensive state mental 

health plan.

2.5 Protect and enhance the rights of 

people with mental illnesses.

7.2.1 Insurance Coverage and Parity for 

Mental Health Services

In 66 percent of reporting states (33 of 

50), the state mandates mental health 

insurance benefits. In 28 states, the mandate 

includes parity with physical health service 

benefits. In 14 states, these mental health 

insurance benefits are limited to specific 

mental health diagnoses. For example, in 

several states mental health services are 

limited to diagnoses of: schizophrenia, 

schizoaffective disorder, bipolar disorder, 

major depression, panic disorder, obsessive 

compulsive disorder, and autism. In 5 states, 

the insurance benefits are limited to mental 

illnesses, but not substance abuse services, 

and in 10 states, both mental health and 

substance abuse services are covered.

7.2.2 Recognition and Treatment of Persons 

With Mental Illnesses by Primary Care 

Providers

In 64 percent of the states (32), the SMHA 

is collaborating with the state health 

department to increase the recognition and 

treatment of persons with mental illnesses. In 

31 states, the SMHA is working with the 

state Medicaid agency regarding primary 

care providers. 
58 Funding and Characteristics of State Mental Health Agencies, 2007

In 70 percent of the states (35), the SMHA 

is working with public health providers 

(community health clinics, state health 

agencies, and other public providers) to 

increase the recognition and treatment of the 

physical health needs of persons with mental 

illnesses. In 27 states, the SMHA is working 

with private health providers (e.g., local 

hospitals, physician groups).

7.2.3 Individualized Treatment Plans

Almost all SMHAs (96 percent or 48 of 

50) report having initiatives under way to 

ensure every consumer receives an 

individualized person-centered treatment 

plan to meet his or her unique needs. Among 

the states that reported having no initiatives 

under way, some reported this is a wellestablished requirement, and thus no new 

initiatives were needed. In 34 states, the 

SMHA provides training and assistance to 

providers in developing person-centered 

treatment plans. In 28 states, the SMHA 

receives information on individualized 

treatment plans from community mental 

health providers. 

7.2.4 Recovery Orientation 

The PNFC recommended that mental 

health systems “involve consumers and 

families fully in orienting the mental health 

system toward recovery.” SAMHSA has 

developed a consensus definition of recovery 

as follows: 

Mental health recovery is a journey of healing 

and transformation enabling a person with a 

mental health problem to live a meaningful life in 

a community of his or her choice while striving to 

achieve his or her full potential (SAMHSA, 2004).

State mental health agencies have 

embraced the concept of recovery for 

consumers, and most SMHAs (43) have now 

ad

the p

their 

healt

7.2.5 

S

with 

receiv

ment

and s

sever

provi

choic

opted a mission statement or policy about 

otential for consumers to recover from 

illnesses and to reorient the mental 

h service system towards recovery.

Consumer Involvement in Mental 

Health Systems

MHAs are working to provide consumers 

choice with respect to services they 

e and a stronger voice in the design of 

al health systems and how resources 

ervices are allocated. Table 19 shows 

al areas where SMHAs are working to 

de increased decision-making and 

e to consumers.

Table 19: How SMHAs Promote Consumer 

Choice (Number of SMHAs Reporting)

Initiatives Children Adults

Consumer participation in program 

planning at the SMHA level 45 46

Access to satisfaction and outcome 

data on mental health programs 41 43

Psychiatric advanced directives 16 40

Consumer participation in resource 

allocations at the SMHA level 33 35

Person-centered and consumerdirected individualized treatment 

and support plans

6 32

Consumer participation 

resource allocations

in their own 16 18

Voucher system for individuals 

purchase services of their own 

choice

to 

6 10

7.2.6 Psychiatric Advanced Directives

SMHAs are supporting psychiatric 

advanced directives through state statutes 

and policies. In 28 states, there is a general 

state statute on advanced directives, while in 

20 states, there is a statute specific to mental 

health (in 10 states, there is both a specific 

mental health statute and a general state 

advanced directive statute). In eight states, 

there is no specific advanced directive statute, 
Funding and Characteristics of State Mental Health Agencies, 2007 59

but the SMHA has a policy or rule to 

encourage their use. Six SMHAs reported 

they have no statutes or policy on advanced 

directives.

7.2.7 Types of Advanced Directives 

Supported

Living wills (expressing one’s own wishes 

for treatment in the event she or he lacks 

capacity in the future) are permitted/

encouraged in 32 SMHAs. The appointment 

of health care proxies/representatives is 

permitted/encouraged in 31 SMHAs. 

7.2.8 Comprehensive Mental Health Plans

Many SMHAs (37 of 50) have broadened 

their mental health planning process to 

encompass the delivery of mental health 

services across multiple state government 

agencies. In 31 states, the state mental health 

plan addresses the mental health services and 

essential support services provided by state 

agencies other than the SMHA. In every 

state, representatives from other state 

government agencies participate as members 

of the SMHA’s mental health planning 

council.

7.2.9 Fragmentation

All but one SMHA (94 percent) reported 

working to transform the way they deliver 

mental health services by restructuring or 

combining services in a new approach to 

eliminate barriers and promote consumer 

choice. Most SMHAs reported they are 

working to reduce the fragmentation in 

services experienced by consumers as a 

barrier to receiving mental health services. 

Substance abuse services (45 states), housing 

services (46 states), Medicaid (43 states), and 

criminal justice (43 states) were the most 

frequently identified areas of state initiatives.

Table 20 shows that most SMHAs have 

initiatives under way to work with other 

state government agencies to coordinate, 

reduce, or eliminate barriers between 

delivery system and funding streams to 

assure the provision of appropriate mental 

health services. Although many of these 

initiatives focus on reducing fragmentation 

between systems, many states are also 

working to coordinate client eligibility 

determinations, funding streams, and service 

delivery. For example, Connecticut reports 

that “fourteen (14) state agencies and the 

Table 20: SMHAs Have Initiative Under Way to Work With Other State Government Agencies to 

Coordinate, Reduce, or Eliminate Barriers Between Delivery Systems and Funding Streams 

(Number of SMHAs Reporting)

Agency Reduce 

Fragmentation

Client Eligibility 

Determination

Combine or 

Coordinate Funding 

Streams

Combine or 

Coordinate Service 

Delivery

Medicaid 41 32 35 35

Child Welfare 42 20 29 37

Health 40 14 24 31

Education 39 13 24 33

Juvenile Justice 38 18 25 35

Corrections 37 19 19 31

Housing 38 19 29 31

Other state agency 11 5 6 8
60 Funding and Characteristics of State Mental Health Agencies, 2007

Judicial Branch, through a signed 

Memorandum of Understanding, are 

working together through the Mental Health 

Transformation State Incentive Grant (MHT 

SIG) on a wide variety of initiatives including 

workforce development, different utilization 

of waivers, sharing data, and collaborating 

on models of treatment.”

7.2.10 Child Custody Relinquishment

One of the problem areas identified by the 

PNFC was the need for some families to give 

up custody of their own child for the child to 

receive needed mental health services. This is 

described as “the tragic and unacceptable 

circumstances that result in thousands of 

parents being forced to place their children 

into the child welfare or juvenile justice 

system each year so that they may obtain the 

mental health services they need” (US 

DHHS, 2003, p. 33).

SMHAs and states have been working to 

change their eligibility requirements and 

policies to end the need for parents to 

relinquish custody for their children to 

receive services. Thirty of 47 reporting states 

indicate their state has laws or policies 

designed to avoid parents having to 

relinquish custody of children for them to 

obtain mental health services. For example, 

Iowa reported it has “a Medicaid Children’s 

MH Waiver that started July 1, 2005; [it is] 

no longer necessary for parents to relinquish 

custody for PMIC [Psychiatric Medical 

Institute for Children] admissions.”

Even the states who reported they do not 

have a policy in place to eliminate custody 

relinquishment frequently reported they have 

initiatives under way to reduce or eliminate 

custody relinquishment. For example, 

Oklahoma reported, “Oklahoma is creating 

a care coordination system to ensure receipt 

of mental health services.” And Virginia 

reported, “There is large policy change 

initiative underway to issue new foster care 

guidelines that avoid parental relinquishment. 

Work is not yet complete.”

7.2.11 Services to Veterans and Military 

Members

The mental health needs of the National 

Guard, the military, and veterans have been 

highlighted by several new studies of the 

needs of soldiers, sailors, and marines 

returning from military conflicts. SMHAs 

are working with the Veterans Department 

and Department of Defense to help meet the 

needs of these members:

■ Twenty-seven of 49 reporting SMHAs are 

working with their state National Guard

■ Twenty-nine are working with the Federal 

Department of Veterans Affairs

■ Three are working with the Federal 

Department of Defense

With regard to examples of state activities 

working on veterans’ mental health, 

Delaware reported establishing Front Door 

Teams at the community mental health 

center (CMHC) system to create an “open 

door” to mental health services. Individuals 

served, including veterans, are assisted with 

immediate mental health service supports. 

Connections are made to veteran centers, the 

state Veterans Administration hospital, and 

other outpatient providers funded by the 

Veterans Administration.

Maryland reported developing a pilot 

program with the Maryland National Guard; 

the Maryland Defense Force; and the 

Maryland, Virginia, and Federal Veterans 

Administrations. A pilot program provides 

training for the Maryland National Guard 

Family Readiness Program for recognizing 

the signs of posttraumatic stress disorder in 

returning veterans.
Funding and Characteristics of State Mental Health Agencies, 2007 61

New Hampshire reported being a member 

of the advisory board of the Disaster 

Behavioral Health Response Team (DBHRT) 

under the Office of Homeland Security. The 

state participates in Operation Welcome 

Home with the National Guard by 

contracting for services from CMHCs. The 

state also offers some housing for mentally ill 

veterans.

Examples of State Activities Related to 

Veterans’ Mental Health

Delaware: Front Door Teams have been 

established in the CMHC system to create 

an “open door” to mental health services. 

Individuals serving on these teams, including 

veterans, are assisted with immediate mental 

health service supports. Connections are 

made to veteran centers, the state Veterans 

Administration (VA) hospital, and other 

outpatient VA-funded providers.

Maryland: Maryland developed a pilot program 

with the Maryland National Guard; the Maryland 

Defense Force; and the Maryland, Virginia, 

and Federal VA. The pilot program provides 

training for the Maryland National Guard Family 

Readiness Program on recognizing signs of 

PTSD of returning veterans.

New Hampshire: New Hampshire is a member 

of the Advisory Board of the Disaster Behavioral 

Health Response Team (DBHRT) under 

the Office of Homeland Security. The state 

participates in Operation Welcome Home with 

the National Guard and contracts for services of 

the CMHCs. There is some housing for mentally 

ill veterans.

7.2.12 Housing

Most states (74 percent) have developed a 

housing plan to address the housing needs of 

persons with SMI. SMHAs reported having 

211 full-time employees (FTEs) employed or 

contracted by the SMHA to address housing 

issues for persons with mental illnesses (35 

states reporting). Nineteen SMHAs reported 

the number of FTEs working on housing has 

recently changed, almost always the result of 

an increase in the number of staff dedicated 

to housing. For example, Arizona reported 

that a new housing coordinator was 

established within the SMHA in the summer 

of 2005.

Ninety-two percent of SMHAs (46 states) 

and 70 percent of local mental health 

authorities (35 states) support and 

collaborate with community development 

corporations or housing authorities in local 

communities. SMHAs report they have 

working interagency relationships with 

several other agencies regarding housing 

issues:

■ State social services agency (47 states)

■ State coalition for homeless persons (45 

states)

■ State aging agency (40 states)

■ State department of housing/community 

development (38 states)

■ State housing finance agency (35 states)

■ State affordable housing coalition (30 

states)

SMHAs were asked to assess what 

barriers impede their ability to address 

consumer housing needs. Table 21 presents 

the percent of SMHAs that rated the housing 

issues as “very significant” or “significant” 

barriers.

7.2.13 Criminal Justice and Mental Illnesses

The PNFC found that “too often, the 

criminal justice system unnecessarily 

becomes a primary source of mental health 

care” (US DHHS, 2003, p. 43) and called for 

more programs to divert persons with mental 

illness from the criminal justice system into 

services. In 2007, most states had some form 

of criminal justice diversion programs (see 

Figure 21). 
62 Funding and Characteristics of State Mental Health Agencies, 2007

Table 21: Barriers That Impede the SMHAs’ 

Ability to Address Consumer Housing Needs

Barriers to Housing Percent 

of States

Consumer income is insufficient to afford private 

market rate housing 89%

Insufficient availability of subsidized housing 80%

Insufficient funding for development of affordable 

housing 70%

Insufficient funding for necessary support 

services 59%

Other housing issues 57%

Community opposition (NIMBY—not in my back 

yard) 29%

Lack of data/information about housing 28%

Lack of coordination between agencies 26%

Managed care organizations do not support 

housing 23%

Fair housing issues for consumers 11%

Poor relationship with housing agencies/housing 

providers 7%

7.2.14 Mental Health Courts

Thirty-six SMHAs reported they have 

mental health courts designed to help divert 

persons with mental illnesses from the 

criminal justice system into mental health 

treatment. In 2007, 29 states reported they 

had 134 mental health courts operating (an 

average of 4.6 courts per state). These mental 

health courts saw 6,242 persons, an average 

of 367.2 persons per state during the year (17 

states reporting). In 16 states, the mental 

health courts have dedicated new resources 

to provide community-based mental health 

treatments. Eleven states reported a total of 

$9,661,398 devoted to mental health courts, 

an average of $878,309 per state.

Figure 21: States With Mental Health Court and/or Jail Diversion Programs

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure21.html
Funding and Characteristics of State Mental Health Agencies, 2007 63

7.2.15 Prebooking Diversion Programs for 

Adults 

Prebooking diversion programs are 

interventions designed to work with police to 

divert persons with mental illnesses into 

services before they are charged with a 

crime. In 2007, 38 states reported they have 

adopted such programs to help divert adults 

with mental illnesses into treatment. During 

the last 2 years, 25 SMHAs reported having 

activities or funding to stimulate or support 

prebooking diversion programs. Over the 

next fiscal year, 25 states anticipate they will 

have funding or activities to stimulate 

prebooking programs.

7.2.16 Postbooking, Preadjudication Diversion 

Programs for Adults 

These programs are interventions designed 

to work with the police and courts to divert 

persons into mental health services after they 

have been arrested or charged with a crime. 

In 2007, 30 states reported they have 

adopted postbooking preadjudication 

diversion programs to divert adults with 

mental illnesses into treatment. During the 

last 2 years, 29 states reported they have had 

activities or funding to stimulate or support 

postbooking diversion programs. Over the 

next fiscal year, 28 states anticipate they will 

have funding or other activities to support 

postbooking, preadjudication diversion 

programs.

7.2.17 Youth Diversion Programs

In 2007, 29 states reported they support 

programs to divert youth with mental 

illnesses from the juvenile justice system into 

mental health services. In 18 states, these 

programs are designed to divert youths at 

adjudication. In 16 states, youths are diverted 

at intake to the juvenile justice system, and in 

14 states, youths are diverted prearrest 

(before charges are filed). Youth diversion 

programs are administered by the SMHA in 

8 states, while they are administered jointly 

by the SMHA and the state juvenile justice 

agency in 13 states, and by only the state 

juvenile justice agency in 5 states. 

7.2.18 Reentry Programs

In 34 states, the SMHA has adopted, 

funded, or operated reentry programs 

designed to provide supports for prisoners or 

jail detainees with mental illnesses and/or 

co-occurring substance abuse disorders who 

are returning to the community. For 

example, in Texas, the Texas Correctional 

Office on Offenders with Medical and 

Mental Impairments provides funding for 

continuity of care personnel at local mental 

health agencies (LMHAs) statewide. LMHA 

continuity of care personnel are responsible 

for linking individuals to appropriate 

community supports upon release from 

prison. 

7.3 Goal 3: Disparities in Mental 

Health Services Are Eliminated

Goal 3 is subdivided as follows: 

3.1 Improve access to quality care that is 

culturally competent.

3.2 Improve access to quality care in rural 

and geographically remote areas.

7.3.1 Cultural Competence

Sixty-eight percent of SMHAs (34 of 50 

states) report they have a cultural 

competence plan. In 24 states, the cultural 

competence plan covers all administrative 

organization components in its purview (i.e., 

cultural competence is a requirement and 

responsibility at all administrative and 

organizational levels within the SMHA). In 
Fu64 nding and Characteristics of State Mental Health Agencies, 2007

32 states, the cultural competence plan 

addresses linguistic competencies (see Table 

22).

In 18 states, the SMHA has conducted a 

cultural competence assessment. The 

NASMHPD/NRI State Mental Health 

Agency Cultural Competence Assessment 

Instrument was used in three of these states.

7.3.2 Workforce Initiatives

Almost all SMHAs reported they are 

experiencing shortages of trained staff with 

appropriate clinical training. Most states (46 

of 50) report they have initiatives to improve 

the quality of their mental health workforce. 

Figure 22 shows that almost every state is 

experiencing a shortage of psychiatrists 

willing to work in the public mental health 

system, but states are also experiencing 

major shortages of registered nurses, 

advanced practice nurses, social workers, and 

other professional disciplines. 

Table 22: SMHA Cultural Competence 

Activities Needs

To help address these staff shortages, 

SMHAs are engaged in several initiatives 

including:

■■ Special university-based training initiatives 

(36 states)

Activities Number 

of States

SMHA provides or assists organizations in 

obtaining training materials for clinical staff in the 20

use of interpreters

SMHA provides or helps organizations to obtain 

educational materials translated into identified 19

languages

Provider and service 

key languages

directories are available in 18

Standards exist for qualified mental health 

interpreters 16

Language 

updated

skills of staff are monitored and 32

■■ Training at mental health programs/

providers (36 states)

■■ Increased salaries (33 states)

■■ Recruitment bonuses or other financial 

incentives (21 states)

■■ Other, such as loan forgiveness, tuition 

benefits (18 states)

Almost all states (88 percent) reported on 

special initiatives to cross-train staff to meet 

the needs of dual diagnosis, mental health 

and substance abuse services.

7.3.3 Workforce Improvement

Most SMHAs (46) have initiatives to 

improve the quality of their mental health 

workforce. In most states, mental health 

consumers (37) and the family members of 

mental health consumers (33) are involved in 

the training of SMHA staff, including 29 

where both are used.

7.3.4 Prescription Privileges and the Use of 

Licensed Health Care Providers

Nurse practitioners, advanced practice 

nurses, physician assistants, and other 

licensed health care providers are given 

prescription privileges or may monitor 

medications in many state psychiatric 

hospitals and community mental health 

systems. They have these privileges in state 

psychiatric hospitals in 35 states and with 

community mental health providers in 37 

states.

These nonphysicians monitor medication 

in 35 states, are given prescription privileges 

in 36 states, and may collect patient histories 

and conduct physicals in 33 states. In some 

states, they are also allowed to manage and 

lead groups, complete diagnostic evaluation 

discharge summaries, consult with patients, 
Funding and Characteristics of State Mental Health Agencies, 2007 65

Figure 22: SMHA Shortages of Mental Health Staff by Discipline, 2007

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure22.html

and provide emergency certificates to have 

patients involuntarily transported to the 

emergency departments of general hospitals 

for psychiatric evaluations. 

Psychologists are granted by state 

legislation privileges to use preapproved 

formularies, and in collaboration with a 

physician, to diagnose and assess, formulate 

treatment plans, and lead treatment teams. In 

40 states, nurse practitioners have 

prescription privileges; in 28 states, physician 

assistants have prescription privileges; and in 

2 states, advanced practice nurses have 

prescription privileges. 

7.3.5 Staffing in State Psychiatric Hospitals

Forty-three states reported over 110,000 

staff in 2007 in state psychiatric hospitals, 

76,000 of whom were direct patient care 

staff and 30,000 were indirect care (support 

and administrative) staff.

7.3.6 Rural/Frontier Services

Almost three-quarters of the states (74 

percent) reported they have initiatives to 

increase access to mental health services in 

rural and geographically remote areas. These 

initiatives include telemedicine initiatives in 

19 states and rural outreach efforts.

In almost half (46 percent) of the states, 

the SMHA has initiatives to recruit and train 

rural mental health professionals. Examples 

of state initiatives include residency and 

traineeship programs that focus on provision 

of services in rural mental health settings 

(Ohio) and physician bonuses paid for rural 

service. Oklahoma reports working with the 

department of health on issues relating to 

health professional shortage areas, providing 

a seminar series, and linking with Oklahoma 

State University to focus on rural health 

education. 
Fu66 nding and Characteristics of State Mental Health Agencies, 2007

7.4 Goal 4: Early Mental Health 

Screening, Assessment, and 

Referral to Services Are Common 

Practice

Goal 4 is subdivided as follows: 

4.1 Promote the mental health of young 

 children.

4.2 Improve and expand school mental 

 health programs.

4.3 Screen for co-occurring mental health 

 and substance use disorders and link 

 with integrated treatment strategies.

4.4 Screen for mental disorders in primary 

 health care, across the life span, and 

 connect to treatment and supports.

7.4.1 Screening for Mental Health Problems

Almost all SMHAs report they have 

initiatives for the early detection of mental 

health problems (see Figure 23). Most states 

(84 percent or 42 of 45 reporting) have some 

form of early detection initiative. In 40 

states, these initiatives are for children, in 19 

states for adults, and in 10 states for older 

adults.

Nearly all SMHAs (92 percent) report 

they are working with schools to expand and 

improve mental health services for children. 

State initiatives with schools include 

providing training and technical assistance to 

schools and funding services provided in 

schools. For example, Texas reported a 

“school-based services initiative and early 

childhood mental health project. SMHA 

State Examples of Goal 3 Initiatives

California: Since 1998, the Department of Mental Health has required local county mental health systems to 

track and report disparities and develop local objectives to reduce and/or eliminate them. The American Mental 

Health Alliance (AMHA) annually provided disparities Medi-Cal data to all local mental health authorities. The 

SMHA Cultural Competence Advisory Committee is currently updating and rewriting new cultural competence 

plan requirements for review and approval by SMHA for statewide distributions. The primary focus is reduction 

of disparities and improved quality of care. The Department of Mental Health has completed and piloted the 

California Brief Multicultural Competence Scale and Training program (a 32-hour training program for providers 

to improve cross-cultural mental health services). This is a comprehensive multicultural curriculum developed 

in partnership with University of Le Verne and the California Mental Health Directors Association. This product 

will be available nationally through Sage publishing company. The department has engaged in a contract with 

the Center for Reducing Health Disparities, at UC Davis, to develop resources and provide technical support to 

local counties to improve their community outreach and engagement with communities that have a history of 

disparities in mental health. Language access: SMHA is now completing a mental health interpreter’s training 

program to address disparities resulting from limited language access. The State Quality Improvement Council 

tracks statewide disparities and reports out to local mental health plans. The Medi-Cal State External Quality 

Review contractor includes items in the review protocol on mental health disparities and reports out results.

Connecticut: The Department of Mental Health and Addiction Services (DMHAS) has developed gender-specific 

guidelines for providers to ensure responsiveness to the particular characteristics and needs of women in 

treatment programs at all levels of care. Data collection, data sharing, and the use of data to identify disparities 

and inform decision-making to eliminate those disparities is an area of focus for the MHT SIG. Connecticut’s 

Network of Care website www.ct.networkofcare.org contains mental health–related information in 14 different 

languages.

Georgia: The Georgia Crisis and Access Line (G-CAL) coordinates with community providers and crisis 

stabilization programs to provide access to routine and emergency mental health and substance abuse services. 

G-CAL provides triage and direct access to appointments with community providers and deployment of crisis 

services. The group can also provide consumers with choices based on time of access, distance, and consumer 

preference.
Funding and Characteristics of State Mental Health Agencies, 2007 67

Figure 23: SMHA Early Detection of Mental Health Problem Initiatives

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure23.html

contracted providers to provide mental health 

services within schools to eligible youth. The 

SMHA also funds staff within the 20 

regional educational resource centers to 

provide training and technical assistance to 

school personnel and community 

stakeholders about improving mental health 

services for children in schools.”

Almost all SMHAs (96 percent) require or 

work with mental health providers to screen 

for co-occurring mental health and substance 

abuse disorders. Over half (56 percent or 28 

states) of the SMHAs that reported require 

or work with mental health providers to 

screen for histories of trauma in persons 

served by the public mental health system. 

Nine SMHAs reported they provide or make 

referrals for specialized trauma treatments or 

services. Fifteen states compile information 

on the number of persons with a history of 

trauma who are receiving mental health 

services.

7.4.2 Older Adult Mental Health Services

Half (50 percent) of the SMHAs (25 

states) have a specialized plan for the 

provision of mental health services for older 

adults (persons aged 65 and over). In 24 

states, the SMHA provides specialized 

training to providers regarding older adult 

mental health services needs and issues in the 

recognition of mental illnesses.

7.5 Goal 5: Excellent Mental Health 

Care Is Delivered and Research 

Is Accelerated

Goal 5 is subdivided as follows: 

5.1 Accelerate research to promote recovery 
68 Funding and Characteristics of State Mental Health Agencies, 2007

State Examples of Goal 4 Initiatives

Delaware: Community mental health utilizes Early Periodic Screening Diagnosis Testing (EPSTD) to identify 

children who may be in need of help with behavioral and/or emotional problems and/or have risk factors 

associated with the development of behavioral and/or emotional problems. The tool facilitates early detection 

of mental health problems, documentation of service entry needs, and identification of strengths. The Division 

of Substance Abuse and Mental Health (DSAMH) is collaborating with state emergency rooms (ERs) to provide 

appropriate assessment of mental health/substance abuse conditions to prevent inpatient care. The Crisis and 

Psychiatric Emergency Services (CAPES) and high-end user programs assure clients are provided with access 

to appropriate services and supports.

Delaware: DSAMH is collaborating with the adult justice system to connect consumers to mental health 

treatment through a Court of Common Pleas Mental Health Court and a Superior Court Drug Court. The 

community mental health center (CMHC) is planning to implement a child and family-oriented mental health 

court. DSAMH is collaborating to provide substance abuse and mental health treatment services to offenders 

involved in a statewide reentry initiative. The PATH Program connects homeless consumers who are mentally ill 

with services. The Comprehensive Neuroscience (CNS) program looks at psychiatric medication prescriptions 

from all doctors for Medicaid programs. The program can identify addictive medications and monitor best 

practice standards among doctors’ prescriptions.

Indiana: The SMHA implemented a project with the Department of Child Services (DCS) for mental health 

screening of all youth placed in substitute care. This project has expanded to include other youth served by DCS. 

The project has included an evaluation component implemented by a local university researcher. The evaluation 

is demonstrating that early intervention with these youth results in greater stability of living situation and lower 

cost over time. The SMHA is working with the state bar association on a similar project to screen youth in 

juvenile detention facilities.

and resilience, and ultimately to cure and 

prevent mental illnesses.

5.2 Advance evidence-based 

practices using dissemination 

and demonstration projects, and create 

a public-private partnership to guide 

their implementation.

5.3 Improve and expand the workforce 

providing evidence-based mental health 

services and supports.

5.4 Develop the knowledge base in four 

understudied areas: mental health 

disparities, long-term effects of 

medications, trauma, and acute care.

7.5.1 Moving Research and Evaluations Into 

Practice

The PNFC found there is too long a delay 

in research reaching practice for mental 

health services. SMHAs are undertaking 

several initiatives to shorten this delay. In 

2007, 72 percent of SMHAs (36) had formal 

agreements to work with academia to help 

move research results into better mental 

health services. The purpose is to help ensure 

research and evaluation are carried out in 

areas of high priority to public mental health 

systems; in 60 percent of the states (30), the 

SMHA has formal agreements with 

academia and other researchers to study 

mental health service issues identified by the 

SMHA.

7.5.2 Research and Evaluations by SMHAs

In 2007, most SMHAs were supporting 

research and evaluation on the mental health 

services they provide. Thirteen SMHAs 

reported mental health research is sponsored 

or conducted both within the SMHA and 

outside the SMHA, while in 12 states, 

research is conducted only within the 
Funding and Characteristics of State Mental Health Agencies, 2007 69

Figure 24: Organizational Location of Research and Evaluation

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure24.html

SMHA, and in 12 other states, research is 

only conducted by programs outside the 

SMHA (often at universities with 

relationships to the SMHA). Twelve states 

reported they do not conduct or sponsor 

research (see Figure 24).

Evaluations of mental health programs 

(which are usually less formal than research 

studies) are often designed to understand the 

effectiveness or outcomes of mental health 

services or trainings. More states reported 

they are involved in evaluations than 

research. In 16 SMHAs, mental health 

evaluations are sponsored or conducted both 

within and outside the SMHA, while in 22 

states, evaluations are conducted only within 

the SMHA, and in 6 other states, evaluations 

are only conducted by programs outside the 

SMHA (often at universities with 

relationships to the SMHA). Only three 

states reported they do not conduct or 

sponsor evaluations.

In seven states, the state has an SMHAoperated research center/institute. In 13 

states, the state funds a research center/

institute that is not part of the SMHA.

7.5.3 Types of SMHA-Conducted Research/

Evaluation 

SMHAs report they are focusing their 

research and evaluation efforts on several 

areas, the most common being: client 

outcomes (42 states), service activity 

utilization rates (40), changes in functioning 

and service utilization (35), client utilization/

penetration rates (35), and expenditures per 
70 Funding and Characteristics of State Mental Health Agencies, 2007

outcomes—cost-benefit and cost-effectiveness 

studies (14).

7.5.4 Evidence-Based Services

The following is from a 1999 Surgeon 

General’s Report:

State-of-the-art treatments, carefully refined 

through years of research, are not being 

translated into community settings. . . . A gap 

persists in the broad introduction and application 

of these advances in services delivery to local 

communities, and many people with mental 

illness are being denied the most up-to-date and 

advanced forms of treatment (US DHHS, 1999, p. 

455).

For several years, SMHAs have focused on 

improving the quality of the mental health 

services they provide to reflect the latest 

scientific research on effective services. 

However, for many years, the difficulty of 

moving the most effective treatments from 

clinical research studies into common 

practice has been recognized as a major issue 

in both general medicine and in public 

mental health services in particular. In 1999, 

the above-mentioned Surgeon General’s 

report on mental health found that “gaps 

also exist between optimally effective 

treatment and what many individuals receive 

in actual practice setting” (US DHHS, 1999, 

p. 102). The report also identified several 

practices and steps to improve the quality of 

care provided to mental health consumers.

In 2006, the Institute of Medicine 

concluded that “poor care hinders 

improvement and recovery for many. 

Numerous studies document the discrepancy 

between the [mental health and substance 

use] care that is known to be effective and 

the care that is actually delivered” (IOM, 

2006, p. 35). 

To help public mental health systems 

address the difficulties of implementing 

EBPs, SAMHSA has undertaken several 

major initiatives. CMHS supported the 

development of six toolkits to help states, 

Figure 25: Number of EBPs Being Implemented by States

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure25.html
Funding and Characteristics of State Mental Health Agencies, 2007 71

providers, clinicians, and consumers and 

families implement and use EBP services for 

adults with SMI. Since the original six 

toolkits were published by CMHS, work on 

additional toolkits for supported housing, 

consumer-operated services, and a variety of 

child, adolescent, and older adult EBPs have 

been under development by CMHS. SMHAs 

have responded to Federal leadership on 

EBPs by focusing their attention on 

increasing the number and level of EBPs 

being provided. In 2007, every reporting 

state was implementing at least one of the 

EBPs in the CMHS toolkit, and most states 

were implementing multiple EBPs.

Among EBPs designed for adults with 

SMI, the most frequently implemented EBPs 

were ACT (being implemented in 45 states), 

integrated mental health and substance abuse 

services (in 45 states), and supported 

employment (in 42 states). 

Table 23 shows that not all these EBPs are 

being implemented statewide, but many of 

them are being implemented in parts of a 

state (e.g., ACT teams may be offered only in 

the large urban areas of a state instead of 

statewide). In addition to the EBPs being 

implemented in parts of a state, there are a 

few EBPs being piloted by SMHAs (piloting 

means the SMHA has only one or two initial 

EBPs). There are several EBPs not yet 

implemented by SMHAs, but SMHAs have 

announced plans to implement them. For 

example, family psychoeducation programs 

were in the planning stage in nine states 

during 2007.

Among EBPs designed for children with 

mental illnesses, therapeutic foster care (35 

states), multisystemic therapy (31 states), and 

school-based interventions (30 states) were 

the most frequently implemented EBPs. 

Therapeutic foster care is the EBP with the 

most statewide implementation (17 states), 

while school-based interventions and 

multisystemic therapy (MST) are often not 

available statewide, but instead are offered in 

parts of a state. Wraparound was the most 

frequently listed “other” EBP for children (8 

states). See Table 24 for the implementation 

status of child/adolescent EBPs.

7.5.5 Assertive Community Treatment (ACT) 

ACT is a multidisciplinary clinical team 

approach to providing intensive community 

mental health services to help persons with 

SMI live in the community. Multiple studies 

have demonstrated that ACT services are 

effective in helping individuals with mental 

illnesses avoid psychiatric hospitalizations 

Table 23: Number of SMHAs Implementing or Planning to Implement Adult EBPs

EBP Implementing 

Statewide

Implementing 

Parts of State Piloting Planning To 

Implement

Total 

Implementing 

(Statewide or 

Part)

Assertive Community Treatment (ACT) 11 34 0 1 45

Integrated Mental Health and Substance Abuse 14 29 2 4 45

Supported Employment 20 24 1 1 45

Supported Housing 22 20 0 3 42

Consumer-Operated Services 12 23 2 4 37

Illness Self-Management 7 22 2 6 31

Family Psychoeducation 6 20 0 9 26

Medication Algorithms (Schizophrenia) 6 14 5 4 25

Medication Algorithms (Bipolar) 4 8 1 5 13

Other Adult EBPs 3 13 1 2 17
72 Funding and Characteristics of State Mental Health Agencies, 2007

Table 24: Number of SMHAs Implementing or Planning to Implement Child/Adolescent EBPs

EBP Implementing 

Statewide

Implementing 

Parts of State Piloting Planning To 

Implement

Total 

Implementing 

(Statewide or 

Part)

Therapeutic Foster Care 17 18 0 3 35

School-Based Interventions 5 24 1 1 30

MST (Conduct Disorders) 1 22 8 1 31

Functional Family Therapy 3 19 3 3 25

Other Child EBPs 4 8 0 5 12

and lead more productive lives in the 

community. 

As described above, ACT was the adult 

EBP most frequently offered by states 

(provided in 40 of 51 states responding). In 

11 states, ACT services are available 

statewide, while in 34 states, ACT services 

are available in portions of the state. One 

additional state indicated it is currently 

planning to implement ACT statewide.

Forty states reported they are 

implementing ACT programs consistent with 

published national standards. In 27 states, 

the SMHAs are measuring the fidelity of 

ACT programs. The most frequently used 

method of assessing fidelity is the use of the 

Dartmouth Assertive Community Treatment 

Scale (DACTS) by eight states. States 

reported that ACT teams average a patientto-staff ratio of 14.2 to 1, with a median 

ratio of 10 to 1, a high of 100 to 1, and a 

low of 6 to 1.

A total of 747 ACT programs were 

reported by 40 states, with the median state 

having 6 ACT programs. The range was 

from a high of 88 ACT programs in 

Michigan to a low of 1 ACT program in 

Vermont. The number of persons receiving 

ACT programs was 55,469 (with 31 states 

reporting), and the median number of 

persons receiving ACT was 920. ACT 

services are paid for by a number of funding 

sources, with state general revenues through 

the SMHA and Medicaid the most frequently 

cited methods (see Table 25).

Twenty-four states reported a single 

bundled rate under Medicaid that they have 

used to pay for ACT services. The most 

frequently used Medicaid options to pay for 

ACT services were the Rehabilitation Option 

(30 states) and Medicaid Managed Care 

waivers (10 states).

7.5.6 Supported Employment

Supported employment programs typically 

assist people in obtaining competitive 

employment—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. 

In the 38 states implementing supported 

employment, there were 622 programs 

serving 25,000 individuals. The assessment 

and monitoring of the fidelity of the 

programs was conducted by 14 states using 
Funding and Characteristics of State Mental Health Agencies, 2007 73

Table 25: Funding Sources for ACT

Funding Source Number 

of States

State General Funds 36

Medicaid 36

Federal Mental Health Block Grant 23

Local Funds 14

Other Funds 6

the following methods: Supported 

Employment Fidelity Scale; EBSE Supported 

Employment Scale; Medicaid Provider 

Manual; DACTS; Quality Supported 

Employment Implementation Scale; PORT/

IPS; and Toolkit Model (SAMHSA). State 

general funds were used to provide supported 

employment services in 36 states, Medicaid 

in 17, the Federal Mental Health Block Grant 

in 24, local sources in 12, and various others 

in 15.

7.5.7 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 consumer 

experience, research evidence, expert advice, 

practitioner knowledge, and supportive 

technology (i.e., computer-based). 

In the 15 states implementing medication 

algorithms for schizophrenia, there were 115 

programs serving 54,541 individuals. The 

assessment and monitoring of the fidelity of 

the programs was conducted by three states 

using the following: CAL MAP Fidelity 

Scale, the Inpatient Residential Kit Fidelity 

Measure, and monitoring by Department of 

Mental Health and Developmental 

Disabilities (DMHDD) staff.

State general funds were used to provide 

medication algorithms (schizophrenia) 

services in 17 states, Medicaid in 9, the 

Federal Mental Health Block Grant in 2, 

local sources in 2, and various others in 7.

In the 9 states implementing medication 

algorithms for bipolar disorders, there were 

40 programs serving 34,491 individuals. The 

assessment and monitoring of the fidelity of 

the programs were conducted by one state.

State general funds were used to provide 

medication algorithm (bipolar disorders) 

services in seven states, Medicaid in three, 

the Federal Mental Health Block Grant in 

one, local sources in two, and various others 

in three.

7.5.8 Family Psychoeducation

Family psychoeducation programs are 

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. The programs 

may be either multifamily or single-family 

focused. Core characteristics of family 

psychoeducation programs include the 

provision of emotional support, education, 

and resources during periods of crisis, and 

problem-solving skills.

In the 25 states implementing family 

psychoeducation, there were 222 programs 

serving 8,556 individuals. The assessment 

and monitoring of the fidelity of the 

programs was conducted by seven states 

using the following: agency self-report, 

SAMHSA Fidelity Scale, and Dartmouth 

Fidelity Scale.
74 Funding and Characteristics of State Mental Health Agencies, 2007

State general funds were used to provide 

family psychoeducation services in 23 states, 

Medicaid in 13, the Federal Mental Health 

Block Grant in 16, local sources in 7, and 

various others in 5.

7.5.9 Integrated Dual Diagnosis Treatment 

(Mental Illness and Substance Abuse)

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.

In the 33 states implementing integrated 

dual diagnosis treatment, there were 965 

programs serving 22,180 individuals. The 

assessment and monitoring of the fidelity of 

the programs was conducted by 16 states 

using the following: IDDT Fidelity Scare, 

onsite review, DDCAT, Minkoff-Cline, 

Dartmouth/SAMHSA Fidelity scale, and 

SAMI/CCOE Fidelity Measure.

State general funds were used to provide 

integrated dual diagnosis treatment services 

in 36 states, Medicaid in 28, the Federal 

Mental Health Block Grant in 21, local 

sources in 10, and various others in 10 states.

7.5.10 Illness Self-Management

Illness 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 the individual can 

take care of himself or herself, manage 

symptoms, and learn ways to cope better 

with the illness. Self-management includes 

psychoeducation, behavioral tailoring, early 

warning sign recognition, coping strategies, 

social skills training, and cognitive 

behavioral treatment.

In the 20 states implementing selfmanagement, there were 255 programs 

serving 112,428 individuals. The assessment 

and monitoring of the fidelity of the 

programs was conducted by seven states 

using the following: IMR, Dartmouth/

SAMHSA Fidelity scale, and the General 

Organization Index and SE Toolkit.

State general funds were used to provide 

self-management services in 25 states, 

Medicaid in 9, the Federal Mental Health 

Block Grant in 16, local sources in 4, and 

various others in 5.

7.5.11 Supported Housing

Supported housing refers to services to 

assist individuals in finding and maintaining 

appropriate housing arrangements. This 

activity is premised on the idea that certain 

clients are able to live independently in the 

community only if they have support staff 

for monitoring and/or assisting with 

residential responsibilities. These staff assist 

clients in selecting, obtaining, and 

maintaining safe, decent, affordable housing 

and maintaining a link to other essential 

services provided within the community. The 
Funding and Characteristics of State Mental Health Agencies, 2007 75

objective of supported housing is to help 

obtain and maintain an independent living 

situation.

Supported housing is a specific program 

model in which a consumer lives in a house, 

apartment, or similar setting, alone or with 

others, and has considerable responsibility 

for residential maintenance but receives 

periodic visits from mental health staff or 

family for the purpose of monitoring and/or 

assisting with residential responsibilities. 

Criteria identified for supported housing 

programs include housing choice, functional 

separation of housing from service provision, 

affordability, integration (with persons who 

do not have mental illness), right to tenure, 

service choice, service individualization, and 

service availability.

In the 36 states implementing supported 

housing, there were 944 programs serving 

36,227 individuals. The assessment and 

monitoring of the fidelity of the programs 

was conducted by two states using the 

following: onsite review, Data Source-USTF 

Forms, and site visits, interviews, records, 

and policy reviews.

State general funds were used to provide 

supported housing services in 32 states, 

Medicaid in 11, the Federal Mental Health 

Block Grant in 14, local sources in 8, and 

various others in 12.

7.5.12 Consumer-Operated Services

In the 26 states implementing consumeroperated services, there were 401 programs 

serving 66,120 individuals. The assessment 

and monitoring of the fidelity of the 

programs was conducted by five states using 

the following: MSU (self-survey), Drop-In 

Self-Assessment, and monitoring by SMHA 

staff.

State general funds were used to provide 

consumer-operated services in 28 states, 

Medicaid in 7, the Federal Mental Health 

Block Grant in 22, local sources in 6, and 

various others in 5.

7.5.13 Multisystemic Therapy

Multisystemic therapy (MST) is an 

intensive family and community-based 

treatment that addresses the multiple 

determinants of serious antisocial behavior in 

juvenile offenders. The multisystemic 

approach views individual, family, and 

extrafamilial (peer group, school, 

neighborhood) factors. Interventions may be 

necessary in any one or a combination of 

these systems. MST interventions typically 

aim to improve caregiver discipline practices; 

enhance family affective relations; decrease 

youth association with deviant peers; 

increase youth association with prosocial 

peers; improve youth school or vocational 

performance; engage youth in prosocial 

recreational outlets; and develop an 

indigenous support network of extended 

family, neighbors, and friends to help 

caregivers achieve and maintain such 

changes.

In the 21 states implementing MST, there 

were 129 programs serving 3,151 individuals. 

The assessment and monitoring of the fidelity 

of the programs was conducted by nine states 

using the following: consultation with model 

developer/approved consultants, Therapist 

Adherence Measure, MST training and 

supervision, Adherence Measure and Fidelity 

Implementation (FIMP), and MST Fidelity 

Scale.
76 Funding and Characteristics of State Mental Health Agencies, 2007

State general funds were used to provide 

MST services in 25 states, Medicaid in 21, 

the Federal Mental Health Block Grant in 9, 

local sources in 7, and various others in 7.

7.5.14 Therapeutic Foster Care

Children are placed with foster parents 

who are trained to work with children with 

special needs. Usually, each foster home takes 

one child at a time, and caseloads of 

supervisors in agencies overseeing the 

program remain small. Therapeutic foster 

parents are given a higher stipend than that 

for traditional foster parents, and they 

receive extensive preservice training and 

in-service supervision and support. Frequent 

contact between case managers or care 

coordinators and the treatment family is 

expected, and additional resources and 

traditional mental health services may be 

provided as needed.

In the 30 states implementing therapeutic 

foster care, there were 196 programs serving 

7,843 individuals. The assessment and 

monitoring of the fidelity of the programs 

was conducted by three states using the TFC 

Fidelity Scale and the Parole Model.

State general funds were used to provide 

therapeutic foster care services in 26 states, 

Medicaid in 19, the Federal Mental Health 

Block Grant in 4, local sources in 4, and 

various others in 7.

7.5.15 Functional Family Therapy

Functional family therapy is a phasic 

program where each step builds on another 

to enhance protective factors and reduce risk 

by working with both the youth and their 

family. The phases are engagement, 

motivation, assessment, behavior change, and 

generalization.

In the 18 states implementing functional 

family therapy, there were 62 programs 

serving 911 reported individuals. Using the 

FTT Fidelity Scale, five states conducted 

assessment and monitoring of program 

fidelity.

State general funds were used to provide 

functional family therapy services in 19 

states, Medicaid in 14, the Federal Mental 

Health Block Grant in 4, local sources in 4, 

and various others in 4.

7.5.16 School-Based Interventions

School-based interventions are evidencebased interventions delivered in school 

settings, such as Incredible Years (a teacher 

professional development program to prevent 

and manage disruptive behavioral disorder) 

or Second Step (a violence prevention 

program that teaches children to change 

attitudes and behaviors to reduce 

aggressiveness).

In the 25 states implementing schoolbased interventions, there were 1,402 

programs serving 44,194 reported 

individuals. The assessment and monitoring 

of the fidelity of the programs was conducted 

by four states using Positive Behavioral 

Support, Better Attitudes and Skills in 

Children (BASIC), and Mental Health 101.

State general funds were used to provide 

school-based intervention services in 17 

states, Medicaid in 9, the Federal Mental 

Health Block Grant in 7, local sources in 6, 

and various others in 6.

7.5.17 Older Adult Evidence-Based Practices

Only 11 states were implementing any 

EBPs for older adults. Among those being 

implemented were: ACT; Family 

Psychoeducation; CHARG (consumer-
Funding and Characteristics of State Mental Health Agencies, 2007 77

Rhode Island reported an extensive array of older adult EBP programs:

The Pre-Admission Screening and Annual Resident Review (PASARR) program provides training, consultation, 

and recommendations for treatment planning for nursing facility applicants and residents with mental illness.

The Home Alone Project: Rhode Island Community Mental Health Center (CMHC) Older Adults Services, in 

collaboration with the Leon Mathieu Senior Center Outreach Program, conducts case findings, outreach, 

assessment, treatment, and coordination of services for seniors at risk. The project is funded through a grant 

from the U S Administration on Aging.

Rhode Island CMHC Older Adult Outreach, Emergency Services and Consultation, Gateway Healthcare, Inc., 

provides master’s-level clinician services through the Older Adult Service Program within the CMHC Emergency 

Department; provides in-home assessments and crisis intervention services as needed. 

Rhode Island CMHC Interagency Agreement with visiting nurse agency (VNA); the Visiting Nurse Services of 

Greater Rhode Island is a Rhode Island CMHC (NRI Community Services, Inc.) that established formal written 

agreements (referred to as “strategic alliances,” “cross referral agreements,” “staff leasing contracts”) with the 

VNA and organizations that serve seniors. Example of services include regular team building and mental health 

emergency consultation to homecare supervisors.

Rhode Island CMHC Agreement With State Department of Elderly Affairs; CRA (casework, referral, and 

advocacy) is a Rhode Island CMHC (NRI Community Services, Inc.) that provides CRA to an area agency on 

aging for elders at risk, connecting them to services. 

Rhode Island CMHC Agreement with nonprofit assisted living residence; Evergreen House, NRI Community 

Services, Inc., Housing Corporation, Blackstone Valley Mental Health Realty Corporation, bought, renovated, and 

rented an assisted living residence (ALR) to another nonprofit agency Community Staffing Resources (CSR). CSR 

manages the home as a specialized behavioral health in an ALR.

operated service); PATCH Project in 

Baltimore City; Health Ideas (SelfManagement for Depression); Integrated 

Illness Management and Recovery; 

Dialectical Behavioral Therapy; OATS Grant, 

CSAT Tip 26, Older Adults and Substance 

Abuse; and training on an integrated MH/SA 

model, STAR model. 

Older adult EBPs were planned in 14 

states. Among the older adult EBPs that 

SMHAs were planning to implement were 

outcome-based treatment, planning (Bartels), 

supported employment, ACT, integrated 

mental health/substance abuse services, 

family psychoeducation, cognitive behavioral 

therapy (CBT) for older adult services, 

implementation of SAMHSA toolkit, 

primary care/mental health integration 

model, and illness management.

7.5.18 Training for Evidence-Based Practices

States use varying methods to provide 

ongoing training to providers related to 

implementing EBPs. Most states (45) use 

expert consultants, internal staff (43), 

collaboration with universities (33), and 

provider-to-provider training (27). Some 

states also establish research/training 

institutes to provide training (14), outside 

accreditation organizations (5), SMHA 

training institute (1), funding an ACT center 

to provide training (1), area health education 

centers (1), family-to-family training (1), and 

outside conferences/trainings (1). Half of the 

states (25) are working with academia to 

develop curricula to reflect EBPs, promising 

practices, and value-based practices. 

Half of the SMHAs (26) provide training 

for their workforce for child and adolescent 

EBPs. Some SMHAs provide training for 

consumers (15) and family members (17) for 

child and adolescent EBPs. Most SMHAs 

(34) provide training for their workforce for 

adult EBPs. Half of the SMHAs provide 

training for consumers (24) and family 

members (22) for adult EBPs. Some SMHAs 
78 Funding and Characteristics of State Mental Health Agencies, 2007

(10) provide training for their workforce, for 

consumers (5), and for older adult EBPs (6).

7.5.19 Barriers to Implementing EvidenceBased Practices

Nearly all states have experienced barriers 

to implementing EBPs. The most reported 

barriers were shortages of an appropriately 

trained workforce (46 states), attaining or 

maintaining fidelity to their EBP model 

standards (45), financing programs (44), the 

modification of the EBP model to meet local 

needs (37), and resistance by providers to 

implementing practices (32). Other barriers 

included defining/treating, measuring 

practices, the need for revisions to Medicaid 

rules, lack of consumer and family advocacy, 

and unknown cost/benefit tradeoffs based on 

implementation. 

7.5.20 SMHA Initiatives to Support the 

Adoption of Evidence-Based Practices

All reporting states have initiatives to 

promote the adoption of EBPs. Most states 

have undertaken consensus-building among 

stakeholders (45), promoting awareness and 

providing training (42), monitoring the 

fidelity of practices (35), and incorporating 

EBPs into contracts with service providers 

(31). Many states are modifying information 

systems and data reports (27) and specifically 

requesting funding for EBPs in their SMHA 

budgets (26). Some states are providing 

financial incentives to service providers to 

provide EBPs (13). Other states are 

establishing a best practice advisory 

committee under a court mandate to provide 

EBPs, providing technical assistance to 

service providers, developing an SMHA EBP 

workgroup, establishing a wellness and 

recovery implementation committee, 

providing specialized assistance in change 

management, providing training to parent 

groups, publishing a quarterly best-practices 

newsletter, and establishing stakeholder 

groups. 

7.5.21 Emerging Evidence-Based Practices

Emerging EBPs and innovative practices 

are practices for which the research evidence 

base has not been finalized but appears very 

promising. Most SMHAs (34) are implanting 

or providing emerging EBPs or other 

innovative practices. 

Among the emerging EBPs states are 

pursuing for children and adolescents are: 

trauma treatments, in-home intervention, 

aggression replacement, dialectical behavior 

therapy, child and family wraparound teams, 

restraint reduction using the National 

Technical Assistance Center (NTAC) 

principles, child psychiatric rehabilitation, 

intensive home-based treatment, parents and 

child interactive therapy, juvenile justice 

diversion, suicide prevention, peer support, 

CBT, children’s ACT, consumer-run services, 

psychosocial rehabilitation, transition to 

independence, collaborative problem-solving, 

restraint reduction, and school-based mental 

health services. 

Among the emerging EBPs states are 

pursuing for adults are: peer-led support 

groups; employment/psychiatric 

rehabilitation; self-help centers; Wellness and 

Recovery Action Plans (WRAP); restraint 

reduction; family functional therapy; 

Procovery; jail diversion/reentry programs; 

Native American traditional practices; 

consumer assistance; integrated services for 

mental illness/mental retardation/

developmental disabilities; supported 

education; Fair Weather Lodge; trauma 

screening; wellness clinics; recovery 

education; leadership academies; specific 

mental illness/substance abuse treatment; 

cultural enhancements to treatment; 
Funding and Characteristics of State Mental Health Agencies, 2007 79

dialectical behavior therapy; sequential 

intercept model/CIT crisis intervention; 

strengths-based case management; Compeer, 

peer support; person-centered planning; 

tribal integration in planning; consumer 

assessment; motivational interviewing; 

consumer-run drop-in centers; and suicide 

prevention. 

Among the emerging EBPs that states are 

pursuing for older adults are: integrated 

mental health/primary care, cultural 

enhancements to family psychoeducation, 

outreach, PATCH project in senior housing, 

geriatric specialty teams, and Real Choice 

Grants.

7.5.22 Clinical Practice Guidelines

Clinical practice guidelines and treatment 

recommendations, based on research results 

regarding their efficacy, have been developed 

regarding particular treatments or 

medications. Most SMHAs (26) are engaged 

in education and/or dissemination activities 

related to clinical guidelines and treatment 

recommendations. Twenty-three SMHAs 

reported using clinical guidelines and 

treatment recommendations: 11 were 

following the American Psychiatric 

Association, 9 were following the Texas 

Medication Algorithm Project (TMAP), and 

8 were using the schizophrenia Patient 

Outcome Research Team (PORT). 

Individual SMHAs were also following 

guidelines and recommendations of: 

■ Consensus “Tri-University” Project, 

American Society of Addiction Medicine

■ DMHAS Recovery Guidelines

■ Florida Psychotherapeutic Guidelines

■ NASMHPD, TIP 42

■ Psychopharmacological Guidelines, 

Minkoff (1998)

■ Sowers and Gold (1999)

■ AMHD, Comprehensive Neuroscience 

(CNS) Clinical Indicators

■ New Jersey DMHS Pharmacological 

Practice Guidelines for the Treatment of 

Schizophrenia

■ New York Medication Algorithm Project

■ South Carolina Medication Algorithm 

Project

■ Psychotropic Medication Utilization 

Parameters for Foster Children

■ Texas Department of State Health

■ Hawaii Interagency Performance Standard 

and Practice Guidelines, CAMHD

■ Texas Resiliency and Disease Management 

(Clinical Guidelines)

Several states are using multiple clinical 

guidelines. In Arizona, “Guidelines are 

published via website links to originating 

source or, if proprietary, purchased for use. 

All clinical improvement guidelines are 

matched/compared prior to implementation 

to ensure consistency.” Connecticut is 

“allowing a decentralized approach to the 

use of clinical and recovery guidelines.” In 

New Jersey, “For the guidelines, the 

Division’s work group looked at the 

American Psychiatric Association guidelines 

for the treatment of schizophrenia and Texas 

Medication Algorithm Project (TMAP). 

Some aspects of these two guidelines were 

incorporated into the DMHS guidelines.” In 

New Mexico, the Addiction Severity Index 

(ASI) measures client change over time, and 

the American Society of Addiction 

Medicine’s (ASAM) patient placement 

criteria are used for patient placement. 
80 Funding and Characteristics of State Mental Health Agencies, 2007

State Examples of Goal 5 Initiatives

Maryland: The SMHA Partnership with the University of Maryland School of Medicine, Division of Mental Health 

Services Research, serves to coordinate training/workforce development; train providers in EBPs; and perform 

system evaluation/outcome studies. The SMHA partnership with the University of Maryland and Johns Hopkins 

University Departments of Child Psychiatry and Maryland Coalition of Families for Children’s Mental Health 

serves to implement identified child EBPs and conduct practice-based research.

North Carolina: The North Carolina Practice Improvement Collaborative brings together researchers, mental 

health service providers, consumers, and families to identify and make recommendations regarding EBPs for 

implementation.

Tennessee uses them as part of best practice 

guidelines that are made available to 

providers of behavioral health across the 

state. In Vermont, “These guidelines are 

distributed to the CMHCs for their use. If 

cases have a problematic outcome, the 

CMHCs are requested to review the 

application of the guidelines to that situation 

as part of the review to assure appropriate 

outcomes.”

Clinical guidelines have been selected or 

adopted as official state policy in 10 states 

for the treatment of persons with particular 

mental disorders. Colorado has adopted the 

best practice guidelines of the American 

Psychiatric Association. Florida has adopted 

guidelines in conjunction with Medicaid. In 

Hawaii, “Minkoff’s CCISC, Continuous 

Comprehensive Integrated System of Care 

(Adult Mental Health) and Hawaii’s 

Interagency Performance Standard and 

Practice Guidelines are attached to all 

contracts (children’s MH).” New York 

supports consultation with the OMH 

facilities to develop quality assurance (QA) 

indicators and certification requirements. 

Rhode Island has adopted PACT and 

Individual Placement Support (IPS) for 

individuals who are severely and persistently 

mentally ill (SPMI). Texas has adopted 

TMAP and resiliency and disease 

management (RDM). Utah has adopted 

guidelines “not in community mental health 

centers but in the state hospital.” Vermont 

has adopted guidelines “for schizophrenia, 

major depressive disorder, bipolar disorder, 

and borderline personality disorder.”

Clinical guidelines are being used by 

mental health programs funded, but not 

operated, by the SMHA in 16 states, and by 

community mental health programs operated 

by the SMHA in 10 states. Clinical 

guidelines are being used in all parts of state 

inpatient psychiatric facilities in 14 states. In 

six states, they are used in certain units in 

state psychiatric facilities, such as adult 

treatment units. 

Most of the states using clinical guidelines 

are using them for schizophrenia (22), mood 

disorders (17), and bipolar disorder (13). 

Many of the states are also using them for 

dual disorders (mental and addictive) (12), 

major unipolar depression (11), alcohol abuse 

and dependence (10), substance abuse and 

dependence (8), and anxiety disorders (7). 

Some states are also using them for other 

psychiatric disorders (6), such as Axis II 

(Personality and Mental Retardation 

Disorders) in Diagnostic and Statistical 

Manual of Mental Disorders (DSM) and 

borderline personality disorder and dementia 

(1). Individual states are using clinical 

guidelines for DSM V-codes (V Codes are 

defined in the DSM-IV as “other conditions 

or problems that may be a focus of clinical 

attention,” such as “Noncompliance With 
Funding and Characteristics of State Mental Health Agencies, 2007 81

Treatment” or “Parent-Child Relational 

Problems”) related to parent/child, disruptive 

behavior or misconduct, attention deficit 

disorder, and internal and externalizing 

disorders for children. 

7.6 Goal 6: Technology Is Used to 

Access Mental Health Care and 

Information

Goal 6 is subdivided as follows: 

6.1 Use health technology and telehealth 

 to improve access and coordination 

 to mental health care, especially 

 for Americans in remote areas or in 

 underserved populations.

6.2 Develop and implement integrated 

 electronic health record and personal 

 health information systems.

In 41 states (82 percent), technology is 

being used by SMHAs to help consumers 

access mental health care and treatment 

information. In 42 states, SMHAs are using 

technology and the Internet to provide 

consumers with information about where 

and how to access care. Forty-one states are 

providing information about mental illnesses. 

Seven states are working to make electronic 

personal health information accessible to 

consumers.

Forty SMHAs have initiatives to use the 

SMHA’s website to promote education about 

mental health treatments, services, and 

eligibility (see Table 26). In 21 states, the 

SMHA sponsors a call center to provide 

information about mental health treatments 

and eligibility.

7.6.1 Telemedicine

Most SMHAs (90 percent or 44 states) are 

now engaged in activities to promote the use 

of telemedicine to provide mental health 

services (see Figure 26). In 33 states, the state 

Medicaid Agency reimburses for mental 

health telemedicine services. In 28 states, the 

SMHA itself reimburses for telemedicine 

mental health services. There are four states 

(Arizona, Massachusetts, Oregon, and 

Tennessee) that have recently changed 

licensure or scope-of-practice restrictions to 

promote and encourage the use of 

telemedicine.

7.6.2 Electronic Health Records

Almost all (94 percent) of the reporting 50 

states are implementing or considering the 

adoption of an electronic health record 

(EHR) in their state psychiatric hospitals 

and/or community mental health system (see 

Figure 27).

Four states reported they are already 

operating an EHR with all components in 

their state psychiatric hospitals, while 19 

states reported they have an EHR with some 

components implemented. Nine additional 

states reported they are currently installing 

an EHR system in their state psychiatric 

hospitals, and 14 states are currently 

considering the adoption of an EHR in their 

state psychiatric hospitals (see Figure 28). 

Twenty-one states reported they have 

EHRs installed and operating in the 

community mental health providers that are 

part of the SMHA-funded-or-operated 

Table 26: Type of Information the SMHA 

Makes Available via the Internet

Activities Number 

of States

SMHA provides or assists organizations in 

obtaining training materials for clinical staff in the 20

use of interpreters

SMHA provides or helps organizations to obtain 

educational materials translated into identified 19

languages
82 Funding and Characteristics of State Mental Health Agencies, 2007

Figure 26: SMHA Uses or Promotes Telemedicine for Mental Health

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure26.html

Figure 27: Implementation of EHRs

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure27.html
Funding and Characteristics of State Mental Health Agencies, 2007 83

Figure 28: EHR Status in State Psychiatric Hospitals

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure28.html

system, and four states reported EHRs are 

being installed. An additional 11 states are 

currently considering the adoption of an 

EHR in their community mental health 

provider systems. In four states (the District 

of Columbia, North Dakota, Nevada, South 

Carolina), a single EHR system is used for all 

community mental health providers (all of 

which are operated by the SMHA), while in 

most states (33), community providers use a 

variety of EHR systems.

7.6.3 Implementation of EHR Components

Electronic health records have a variety of 

components that may be implemented by 

mental health providers, and many providers 

have only implemented selected components. 

The level of implementation of components 

varies widely in either state psychiatric 

hospitals or community programs. The most 

commonly implemented components are 

electronic patient admission, discharge, 

transfer components, billing components, 

reporting systems, progress/case 

documentation, and pharmacy. The least 

implemented components are exchanging 

electronic client information with other 

providers for external consultations and 

medication algorithms (see Table 27).

7.6.4 Sharing EHR Information

Twenty states have agreements that allow 

the sharing of EHR client data between 

providers to improve care. In 18 states, these 

agreements allow the sharing of client EHR 

information among the state psychiatric 

hospitals within the SMHA system. In the 

States of North Dakota, South Carolina, 

Texas, Utah, and Virginia, these agreements 

allow sharing information between 

community mental health providers and state 

psychiatric hospitals, while the State of New 
F84 unding and Characteristics of State Mental Health Agencies, 2007

Table 27: EHR Modules Implemented in State 

Psychiatric Hospitals and Community Mental 

Health Providers

State Hospitals Community 

Providers

EHR Components

N Percent N Percent

Patient admissions, 

discharge, transfers 27 84% 16 76%

Pharmacy 23 72% 5 24%

Billing as 

system

part of EHR 23 72% 14 67%

Reporting 20 63% 16 76%

Progress/case 

documentation 18 56% 17 81%

Treatment planning 16 50% 14 67%

Physician order entry 17 53% 5 24%

Clinical assessments 17 53% 15 71%

Scheduling 12 38% 12 57%

Dietary 14 44% 2 10%

Medication algorithms 9 28% 2 10%

Exchanging client info 

with other providers 3 9% 5 24%

External consultations 2 6% 4 19%

Other EHR functions 1 3% 3 14%

York allows the sharing of EHR client 

information between state psychiatric 

hospitals and general hospitals. In Colorado, 

there is an agreement to allow sharing of 

EHR client information between HMOs and 

other managed care firms that are part of the 

public mental health system and the SMHA 

(see Table 28).

Fourteen states (Arkansas, California, 

Georgia, Maine, Michigan, Ohio, 

Oklahoma, Rhode Island, Tennessee, Utah, 

Virginia, Vermont, Wyoming, and the Virgin 

Islands) have a Regional Health Information 

Organization (RHIO) that includes mental 

Table 28: Sharing EHR Information

Sharing EHR Information Between: N Percent

State hospitals within the State 18 55%

Community providers and state hospitals 5 16%

Community providers 5 17%

HMOs, other MCOs, and the SMHA 1 3%

health in its plans to share electronic health 

information. Several other states are 

beginning to assess the inclusion of mental 

health information in an RHIO.

7.6.5 Reported Benefits of Using EHRs

SMHAs reported a variety of benefits 

from implementing and using EHR systems. 

The major benefits reported include 

improved reporting capabilities (17 states), 

enhanced quality assurance (14 states), 

improved productivity (13 states), and 

reduced billing errors (12 states).

7.6.6 Electronic Pharmacy/Medication 

Ordering System

Twenty-six states reported they have 

implemented an electronic pharmacy/

medications ordering system in their state 

psychiatric hospitals, while five states have 

implemented this system in their community 

mental health providers. The electronic 

pharmacy/medications ordering system 

software being used by states includes HCS, 

Meta, Mediworx/Pyxis® system, QSI, 

Quadramed, and WORXS.

7.6.7 Medication Administration Recording

Eleven states reported they have 

implemented the medication administration 

recording (MAR) system in their state 

psychiatric hospitals (Arkansas, Alabama, 

Connecticut, Indiana, Maine, New 

Hampshire, Nevada, Ohio, Utah, Vermont, 

and Wyoming), while no state reported 

having MAR systems in community 

providers.

7.6.8 Electronic Personal Health Records

SMHAs are in the early stages of 

implementing electronic personal health 
Funding and Characteristics of State Mental Health Agencies, 2007 85

State Examples of Goal 6 Initiatives

California: The SMHA, through the Mental Health Services Act, is promoting and funding development of EHRs 

that will increase access to information. The SMHA also funded development of care in every county. The 

California Department of Mental Health’s website (http://www.dmh.ca.gov/Links/default.asp) provides access to a 

broad range of information on effective treatment and available services.

North Dakota: The North Dakota Department of Human Services has implemented an electronic record at the 

regional human service centers. The Department’s website offers a wide range of information on services 

provided.

South Carolina: Through telemedicine, services of psychiatrists fluent in American Sign Language (ASL) are 

provided to all deaf DMH clients. There is ongoing work toward having “telepsych” consultations available to 

all emergency rooms. South Carolina’s DMH is implementing electronic medical records to have information 

available to on-call staff. This will be linked to the DHHS database to provide more medical information to 

facilitate service delivery in the mental health clinics and emergency departments.

records (PHRs). The State of Missouri 

reported being in the processes of 

implementing a PHR, and Oklahoma is 

designing a PHR system for mental health 

clients. The SMHAs in California, Montana, 

New Jersey, Ohio, and Utah are working 

with other providers to support PHRs, while 

Connecticut’s Children’s Mental Health 

Department, Maryland, and Virginia are 

planning on implementing PHR systems.

VIII. SMHA Financing 

of Mental Health 

Services

This section provides a discussion of the funding sources and expenditures of SMHAs.

8.1 Mental Health Expenditures 

Controlled by State Mental 

Health Agencies

In state FY 2005 (the fiscal year that 

ended during calendar year 2005), the 50 

states and the District of Columbia spent 

over $29.4 billion to provide mental health 

services. States averaged mental health 

expenditures of $100 per every resident in 

their state, and SMHA expenditures for 

mental health averaged almost 2 percent of 

total state government expenditures. Because 

of differences in how SMHAs are organized 

and structured, the types of mental health 

services offered and the priority populations 

covered by states, there is considerable 

variation in the level of expenditures among 

the states. State mental health expenditures 

ranged from less than $60 per state resident 

to over $200 per resident in several states 

(see Figure 29). In FY 2005, SMHAs 

reported they provided mental health services 

to nearly 6 million persons (CMHS, 2008). 

The average expenditure per mental health 

service recipient was $4,738, and the median 

was $4,074 per client served.

8.2 Change in SMHA-Controlled 

Expenditures Over Time

From FY 2001 to FY 2005, SMHAcontrolled expenditures for mental health 

services increased from $23.1 billion to $29.4 

billion (see Figure 30). This was an increase 

of 27.9 percent or an average annual increase 

of 6.3 percent. Adjusted for inflation, 

expenditures increased only 8 percent or an 

average annual increase of 1.9 percent. From 

FY 2001 to FY 2005, 46 SMHAs increased 

mental health expenditures, while 5 

decreased their expenditures. During the last 

year (from FY 2004 to FY 2005), 46 

SMHAs reported an increase in total mental 

health expenditures, while 5 states reported a 

decline in mental health expenditures. 

Controlling for inflation, total SMHAcontrolled expenditures failed to keep pace 

with inflation since FY 2001 in 23 states, 

while in 28 states the expenditures surpassed 

inflation. 

From FY 2001 to FY 2005, expenditures 

for community mental health services 

increased by 8.2 percent per year, while state 

psychiatric hospital-inpatient expenditures 

Funding and Characteristics of State Mental Health Agencies, 2007 87
88 Funding and Characteristics of State Mental Health Agencies, 2007

Figure 29: Total FY 2005 SMHA-Controlled per Capita Mental Health Expenditures (in Billions)

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure29.html

Figure 30: Trend in SMHA-Controlled Mental Health Spending, FY 1981 to FY 2005

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure30.html
Funding and Characteristics of State Mental Health Agencies, 2007 89

increased 2.8 percent per year over the 4 

years. When controlled for inflation and 

population growth, community mental 

health expenditures increased 2.6 percent per 

year, while state psychiatric hospitals 

declined by 2.5 percent per year. 

From FY 2001 to FY 2005, 46 SMHAs 

increased their expenditures for community 

mental health services, while 5 SMHAs 

decreased these expenditures. Forty SMHAs 

increased their psychiatric-inpatient hospital 

expenditures, while 11 decreased their 

expenditures. Since FY 2001, inflationadjusted expenditures for community mental 

health increased in 32 states, while they 

declined in 19 states. Inflation-adjusted state 

psychiatric hospital expenditures declined in 

36 states and increased in only 15 states.

Over the 24-year period from FY 1981 to 

FY 2005, SMHA-controlled expenditures 

increased from $6.1 billion to $29.4 billion, 

an increase of 382 percent (an average 

annual rate of 6.8 percent) (see Figure 31).

However, when SMHA expenditures are 

adjusted for inflation, total SMHAcontrolled expenditures increased by only 

23.6 percent over the last 24 years (an 

annualized increase of 0.9 percent). When 

SMHA expenditures are adjusted for 

inflation and population growth, SMHA 

expenditures declined slightly (down 4.6 

percent over the 24 years or 0.2 percent per 

year). 

From FY 1981 to FY 2005, community 

mental health expenditures increased from 

$2 billion to over $20.5 billion, an increase 

of 916 percent (an average increase of 10.1 

percent per year). When community mental 

health expenditures are adjusted for 

population growth and inflation, they 

increased by 101 percent (an average annual 

increase of 3 percent). During this same 

Figure 31: Average Annual Change in SMHA-Controlled Mental Health Expenditures, 1981 to 

2005, by Decade and Type of Program

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure31.html
90 Funding and Characteristics of State Mental Health Agencies, 2007

25-year time interval, state psychiatric 

hospital-inpatient expenditures increased 

from $3.8 billion to $8 billion, an increase of 

108.5 percent (an average annual increase of 

3.1 percent per year). When state psychiatric 

hospital-inpatient expenditures are adjusted 

for both population growth and inflation, 

expenditures actually decreased by 58.7 

percent (an average annual decrease of 3.6 

percent).

8.3 Shift From State Psychiatric 

Hospital-Based Services to 

Community-Based Mental Health

Over the last quarter century, SMHAs 

have shifted their treatment paradigm to 

focus on providing comprehensive mental 

health services in the community. As a result, 

community mental health expenditures have 

grown much faster than state psychiatric 

hospital expenditures. In FY 2005, 

community mental health expenditures 

accounted for 70 percent of total SMHAcontrolled expenditures, and state psychiatric 

hospital-inpatient expenditures were 27 

percent. This is an historic shift from FY 

8.3.1 Variations in SMHA Expenditures

The $29.4 billion in SMHA-controlled 

expenditures in FY 2005 amount to $99.55 

per every civilian resident of the United 

States. The median state—the point where 

25 states were above and 25 states were 

below—expended $89.19 per capita. There 

was wide variation among states in their per 

capita expenditures ($24.23 in New Mexico 

to $269.64 in Alaska). See Figure 33 and 

Tables 29 through 33 for individual state 

data.

SMHAs also varied widely in the 

distribution of their mental health 

expenditures between community-based 

services and state psychiatric hospitals. The 

national average was 70 percent of SMHAFigure 32: SMHA Expenditures for State Psychiatric Hospital Inpatient and Community-Based 

Services as a Percent of Total Expenditures: FY 1981 to FY 2005

1981, when community-mental health 

expenditures accounted for 33 percent of 

SMHA expenditures and state psychiatric 

hospitals were 63 percent of expenditures. 

FY 1993 was the year when community 

mental health expenditures first equaled state 

psychiatric hospital-inpatient expenditures 

(Figure 32).

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure32.html
Funding and Characteristics of State Mental Health Agencies, 2007 91

controlled funds spent on community mental 

health services, which ranged from 91 

percent (in Arizona) to 37 percent (in South 

Dakota).

8.4 SMHA-Controlled Expenditures 

by Type of Mental Health Service

States expended the majority of their 

mental health services monies on communitybased ambulatory (less than 24-hour)

services, a category that includes individual 

and group outpatient services, partial-day 

treatment, medication maintenance visits, 

and a host of other ambulatory services 

(including various EBPs such as ACT, 

supported employment, and integrated dual 

Figure 33: FY 2005 SMHA-Controlled Per Capita Expenditures for Mental Health Services

a = Medicaid revenues for community programs are not included in SMHA-controlled expenditures.

b = SMHA-controlled expenditures include funds for mental health services in jails or prisons.

c = Children's mental health expenditures are not included in SMHA-controlled expenditures.

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure33.html
92 Funding and Characteristics of State Mental Health Agencies, 2007

diagnosis treatment). In FY 2005, SMHAs 

reported they expended $12.8 billion on 

ambulatory services (44 percent) of total 

SMHA expenditures. Almost all (97.5 

percent) of the ambulatory services were 

provided by community-based providers, but 

in some states, the state psychiatric hospitals 

provided outpatient and other ambulatory 

services. In FY 2005, state psychiatric 

hospitals provided $339 million worth of 

ambulatory services.

Psychiatric inpatient expenditures were the 

second largest type of service reported by 

SMHAs. In FY 2005, $10.5 billion (36 

percent of total SMHA expenditures) was 

expended on inpatient services. Although the 

majority of these inpatient services were 

provided in state psychiatric hospitals ($8 

billion), a substantial amount ($2.5 billion or 

23.5 percent) of inpatient expenditures was 

provided by community-based providers 

including CMHCs and general hospitals.

Residential services accounted for $3 

billion of SMHA expenditures in FY 2005 

(10 percent of total SMHA expenditures). 

Although the majority of residential services 

were provided by community-based providers 

($2.66 billion), $295 million worth of 

services were provided at state psychiatric 

hospitals. In FY 2005, $2.4 billion (8 

percent) in SMHA expenditures were 

reported as either an “other” type of service 

or the SMHA was unable to allocate 

expenditures by service type.

Since FY 1981, SMHAs have steadily 

shifted from providing inpatient services in 

state psychiatric hospitals to a system that 

provides more community-based ambulatory 

services. In FY 1981, only 12 percent of 

SMHA expenditures were reported in the 

ambulatory service category, while 65 

percent of total expenditures were reported 

for “inpatient” services (see Figures 34, 35, 

and 36 and Tables 39 and 40).

Figure 34: SMHA-Controlled Mental Health 

Expenditures by Type of Service: FY 1981

Text description of this graphic available 

at: http://www.mentalhealth.samhsa.

gov/cmhs/MentalHealthStatistics/

Figure34.html

Figure 35: SMHA-Controlled Mental Health 

Expenditures by Type of Service: FY 2005

Text description of this graphic available 

at: http://www.mentalhealth.samhsa.

gov/cmhs/MentalHealthStatistics/

Figure35.html
Funding and Characteristics of State Mental Health Agencies, 2007 93

Figure 36: SMHA-Controlled Expenditures by Type of Mental Health Service: FY 1981 to FY 2005 

(in Billions)

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure36.html

8.5 SMHA-Controlled Mental 

Health Spending and Total State 

Government Expenditures

Over the last quarter century, total state 

government expenditures for all purposes 

have grown at a faster rate than SMHAcontrolled expenditures. According to the US 

Census Bureau’s annual report on state 

government finances, in FY 1981, state 

governments expended $291.5 billion for all 

their operations. In FY 1981, SMHAs 

reported expenditures for mental health of 

$6.1 billion, which represented 2.09 percent 

total state government expenditures. Twentyfour years later, SMHA-controlled 

expenditures for mental health were 1.98 

percent of total state government 

expenditures (see Figure 37). If SMHAs had 

received in FY 2005 the same percentage of 

total state expenditures, their expenditures 

would be $1.4 billion, or over 5 percent 

higher than reported for FY 2005.

Over the last 15 years, SMHA 

expenditures as a share of total state 

government expenditures have increased 

slightly. This growth is largely due to the 

increase in SMHA revenues from Medicaid. 

State general fund expenditures for mental 

health have increased more slowly than state 

general fund expenditures for other state 

services over this time period (see Table 29).

Since FY 1997, total SMHA expenditures 

for mental health increased at 9 percent per 

year, a faster annual growth than overall 

state government (which grew 7 percent per 

year), and a rate that was only matched by 

state spending for higher education. 

However, over this time period, most of the 

growth of funds came from Federal sources 

(up 12 percent per year), while state 
94 Funding and Characteristics of State Mental Health Agencies, 2007

Figure 37: Total SMHA-Controlled Mental Health Expenditures as a Percent of Total State 

Government Expenditures: FY 1981 to FY 2005

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure37.html

government funding increased only 6 percent 

per year, a rate of increase below that of 

total state government (where state 

government sources increased at a rate of 7 

percent per year).

Figure 38 shows that SMHA spending as 

a percentage of total state government varies 

widely across the states. Pennsylvania and 

New York devoted the highest percent of 

state budgets to mental health, while New 

Mexico, West Virginia, and Arkansas 

reported the lowest share of state 

expenditures.

8.6 State Tax Dollars Remain the 

Major Source of Funding of 

SMHAs

In FY 2005, 63 percent of SMHA funding 

came from state government sources. This is 

a slight decline from 67 percent in FY 2001. 

In FY 2005, state tax dollars accounted for 

$18.8 billion of funding for SMHA mental 

Table 29: Average Annual Change in State Government Expenditures: FY 1997 to FY 2005

Average Annual FY 1997 to FY 2001 Annual FY 2001 to FY 2005 Change

State Funds Federal Funds Total State Funds Federal Funds Total

 Total state government 7% 7% 7% 4% 8% 5%

 K–12 education 7% 8% 8% 3% 12% 4%

 Higher education 7% 25% 9% 2% 4% 3%

 Public assistance -3% 0% -2% 1% 4% 2%

 Medicaid 6% 7% 7% 10% 9% 9%

 Corrections 8% 1% 7% 3% 8% 3%

 Transportation 5% 10% 7% 3% 6% 4%

 Capital 11% 7% 9% -3% 6% 2%

 All other 8% 5% 7% 3% 7% 4%

 SMHA 6% 12% 9% 5% 8% 6%
Funding and Characteristics of State Mental Health Agencies, 2007 95

Figure 38: SMHA-Controlled Expenditures as a Percent of Total State Government Expenditures: 

FY 2005

* = US Average

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure38.html
96 Funding and Characteristics of State Mental Health Agencies, 2007

Figure 39: SMHA-Controlled Revenues for 

Mental Health, FY 2005

Text description of this graphic available 

at: http://www.mentalhealth.samhsa.

gov/cmhs/MentalHealthStatistics/

Figure39.html

health services. These funding sources 

included state general and special funds of 

over $13.9 billion, and state Medicaid match 

of almost $4.8 billion. The Federal 

government was the second largest funder of 

SMHA services, with FY 2005 dollars 

totaling $9 billion (31 percent of total 

SMHA funding). The majority of Federal 

revenues came from Medicaid ($7.6 billion), 

followed by Medicare ($54 million), other 

Federal Funds ($498 million), and the 

Community Mental Health Block Grant ($40 

million). Local governments contributed 

$407 million (1 percent), and other funds 

contributed the remaining $1.3 billion (see 

Figure 39). Total Medicaid funds (State 

Match and Federal Share) received by 

SMHA-funded programs represented $12.5 

billion (42 percent) of SMHA resources.

Figure 40: SMHA-Controlled Revenues for Mental Health Services: FY 1981 to FY 2005 (in Billions)

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure40.html
Funding and Characteristics of State Mental Health Agencies, 2007 97

SMHA-funded programs represented $12.5 

billion (42 percent) of SMHA resources.

8.7 SMHA Revenue Trends Over 

Time

During the first half of this decade, many 

state governments encountered major budget 

shortages, and total state government 

spending slowed greatly. During this time, 

total SMHA-controlled revenues for mental 

health services increased by 6.3 percent per 

year from FY 2001 to FY 2005. Medicaid 

funding (Federal and state match) increased 

10 percent per year to $12.5 billion, 

representing a slower increase than the prior 

decade (FY 1990 to FY 2001 increased an 

average of 16 percent per year). From FY 

1981 to FY 2005, state general funds 

averaged an increase of 4.7 percent per year, 

while Medicaid grew an average of 11.8 

percent. Other Federal funds increased 7.5 

percent per year over this time period.

As a result of the different rates of growth 

in funding, most of the new funds available 

for SMHA-funded services have come from 

Medicaid. From FY 2001 to FY 2005, 62 

percent of new SMHA funds were from 

Medicaid, while 30 percent of new SMHA 

funds were derived from state general 

revenues to the SMHA. Over the longer time 

period from FY 1981 to FY 2005, half (50 

percent) of all new funds were from 

Medicaid, while state general funds were the 

source of 40 percent of new funds (see Figure 

42 and Tables 36–39).

Most of the growth of Medicaid revenues 

for mental health was used to fund 

community mental health services. From FY 

1981 to FY 2005, Medicaid funds for 

community mental health grew an average of 

25 percent per year. As a result, Medicaid 

(state and Federal shares combined) paid $10 

billion for the SMHA-controlled community 

mental health spending and represented half 

(50 percent) of all funds (see Figure 41). 

For state psychiatric hospitals, Medicaid 

funds grew at a much slower rate (4.5 

percent per year annual rate) and now 
98 Funding and Characteristics of State Mental Health Agencies, 2007

Figure 41: Percent of SMHA-Controlled Community Mental Health Revenues by Major 

Sources: FY 1981 to FY 2005

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure41.html

Figure 42: Percent Increase in SMHA-Controlled Revenues From Major Funding Sources: FY 1981 

to FY 2005

Text description of this graphic available at: http://www.mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/Figure42.html
Funding and Characteristics of State Mental Health Agencies, 2007 99

Table 30: SMHA Mental Health Actual Dollar and per Capita Expenditures by State, FY 

2005

State

SMHA 

Expenditure 

Total

Total Rank 2005 Civilian 

Population

Population 

Rank

FY 2005 per 

Capita

Per Capita 

Rank

Alabama $273,700,000 27 4,538,375 23 $60.31 42

Alaska $173,537,901 35 643,593 47 $269.64 2

Arizona $867,300,000 8 5,931,329 17 $146.22 8

Arkansas (a) $98,639,615 45 2,770,780 32 $35.60 50

California (b) $4,270,200,000 1 35,991,095 1 $118.65 17

Colorado $343,753,830 24 4,627,945 22 $74.28 32

Connecticut(c) $549,200,000 17 3,493,448 29 $157.21 6

Delaware (a, c) $74,768,052 46 838,292 45 $89.19 26

District of Columbia (b) $233,804,705 31 578,151 50 $404.40 1

Florida $647,169,422 14 17,699,814 4 $36.56 48

Georgia $443,973,313 21 9,064,226 9 $48.98 45

Hawaii $192,627,775 33 1,229,552 42 $156.67 7

Idaho $53,884,900 48 1,425,313 39 $37.81 47

Illinois $1,021,700,000 6 12,746,732 5 $80.15 29

Indiana $518,658,624 20 6,264,902 14 $82.79 28

Iowa $235,552,698 30 2,965,148 30 $79.44 30

Kansas $253,700,000 29 2,733,483 33 $92.81 25

Kentucky $208,442,100 32 4,150,496 26 $50.22 44

Louisiana $258,500,000 28 4,488,495 24 $57.59 43

Maine (a) $180,300,000 34 1,314,590 40 $137.15 11

Maryland (b) $776,500,000 10 5,556,347 19 $139.75 10

Massachusetts (a) $685,600,000 12 6,429,227 13 $106.64 18

Michigan (b) $973,500,000 7 10,098,168 8 $96.40 22

Minnesota $669,275,671 13 5,124,774 21 $130.60 13

Mississippi $305,899,702 25 2,894,507 31 $105.68 19

Missouri $414,012,967 23 5,783,136 18 $71.59 34

Montana $124,816,250 40 931,236 44 $134.03 12

Nebraska $106,050,000 43 1,751,276 38 $60.56 41

Nevada $150,500,000 39 2,403,365 35 $62.62 40

New Hampshire $154,908,224 38 1,305,628 41 $118.65 16

New Jersey (b) $1,215,827,000 4 8,694,221 10 $139.84 9

New Mexico (a, c) $46,400,000 51 1,914,935 36 $24.23 51

New York (b) $3,977,500,000 2 19,288,828 3 $206.21 3

North Carolina $1,027,800,736 5 8,577,921 11 $119.82 14

North Dakota $46,760,516 50 628,607 48 $74.39 31

Ohio $757,733,206 11 11,463,260 7 $66.10 37

Oklahoma $157,300,000 37 3,521,352 28 $44.67 46

Oregon $434,558,178 22 3,637,148 27 $119.48 15

Pennsylvania (a, c) $2,541,278,736 3 12,401,208 6 $204.92 4

Rhode Island (c) $102,353,080 44 1,071,255 43 $95.55 23

South Carolina $285,200,000 26 4,212,930 25 $67.70 36

South Dakota $55,081,896 47 771,677 46 $71.38 35

Tennessee $522,000,000 19 5,937,718 16 $87.91 27

Texas (b) $832,200,000 9 22,816,723 2 $36.47 49

Utah $159,884,700 36 2,485,098 34 $64.34 39

Vermont $109,000,000 42 622,302 49 $175.16 5

Virginia (b) $531,500,000 18 7,420,772 12 $71.62 33

Washington $585,485,304 15 6,230,964 15 $93.96 24

West Virginia (b) $118,900,000 41 1,813,479 37 $65.56 38

Wisconsin $579,728,296 16 5,526,732 20 $104.90 20

Wyoming $49,954,234 49 505,654 51 $98.79 21

Total $29,396,921,631 $295,316,207 $99.54 

Average (Mean) $576,410,228 $5,679,158 $103.43 

Median $285,200,000 $3,893,822 $89.19 

Number of States Reporting 51 51 51

(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.

(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.

(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.
100 Funding and Characteristics of State Mental Health Agencies, 2007 State Inpatient Percent Other 24-Hour Services Percent Less Than 24-Hour Services Percent Other Services Percent Research and Training Percent Total SMHA- Controlled Total Rank FY 2005 per Capita Per Rank Alabama $125 45.8% $33.20 12.1% $107 39.2% $7.80 2.8% $274 27 $60.31 42 Alaska $21 12.2% $64.82 37.4% $14 8.0% $68.97 39.7% $4.83 2.8% $174 35 $269.64 2 Arizona $153 17.7% $67.20 7.7% $634 73.1% $13.30 1.5% $867 8 $146.22 8 Arkansas (a) $28 28.6% $28.84 29.2% $35 35.1% $6.90 7.0% $99 45 $35.60 50 California (b) $1,100 25.8% $274.20 6.4% $2,487 58.2% $377.10 8.8% $31.70 0.7% $4,270 1 $118.65 17 Colorado $90 26.2% $3.04 0.9% $2 0.6% $247.39 72.0% $1.30 0.4% $344 24 $74.28 32 Connecticut (c) $206 37.5% $79.60 14.5% $210 38.2% $53.90 9.8% $549 17 $157.21 6 Delaware (a, c) $42 55.5% $6.68 8.9% $25 33.4% $1.63 2.2% $75 46 $89.19 26 District of Columbia (b) $80 34.3% $33.67 14.4% $99 42.2% $21.25 9.1% $234 31 $404.40 1 Florida $386 59.6% $80.15 12.4% $169 26.2% $12.07 1.9% $647 14 $36.56 48 Georgia $202 45.5% NA NA $3 0.8% $238.43 53.7% $444 21 $48.98 45 Hawaii $66 34.4% $46.85 24.3% $71 36.8% $8.70 4.5% $193 33 $156.67 7 Idaho $23 42.6% $5.81 10.8% $25 46.6% $54 48 $37.81 47 Illinois $532 52.1% $98.60 9.7% $373 36.5% $18.10 1.8% $1,022 6 $80.15 29 Indiana $171 32.9% NA NA $344.71 66.5% $3.11 0.6% $519 20 $82.79 28 Iowa $30 12.6% $44.05 18.7% $157.85 67.0% $3.92 1.7% $236 30 $79.44 30 Kansas $69 27.1% NA NA $185.00 72.9% $254 29 $92.81 25 Kentucky $104 49.9% $21.53 10.3% $74 35.4% $9.12 4.4% $208 32 $50.22 44 Louisiana $151 58.5% $4.60 1.8% $85 33.0% $17.20 6.7% $259 28 $57.59 43 Maine (a) $53 29.2% $10.60 5.9% $113 62.6% $4.20 2.3% $180 34 $137.15 11 Maryland (b) $299 38.5% $115.80 14.9% $327 42.2% $34.50 4.4% $777 10 $139.75 10 Massachusetts (a) $194 28.3% $264.00 38.5% $207 30.2% $20.60 3.0% $686 12 $106.64 18 Michigan (b) $335 34.4% $154.40 15.9% $477 49.0% $7.30 0.7% $974 7 $96.40 22 Minnesota $276 41.3% $71.51 10.7% $318 47.5% $3.47 0.5% $669 13 $130.60 13 Mississippi $167 54.7% $0.75 0.2% $7 2.3% $127.61 41.7% $3.04 1.0% $306 25 $105.68 19 Missouri $196 47.4% $37.06 9.0% $170 41.1% $10.66 2.6% $414 23 $71.59 34 Montana $26 20.8% $42.10 33.7% $53 42.3% $3.91 3.1% $125 40 $134.03 12 Nebraska $72 67.7% $4.50 4.2% $23 21.8% $3.50 3.3% $3.15 3.0% $106 43 $60.56 41 Nevada $36 23.9% $26.10 17.3% $85 56.6% $3.30 2.2% $151 39 $62.62 40 New Hampshire $50 32.0% $27.41 17.7% $65 42.0% $9.05 5.8% $3.95 2.5% $155 38 $118.65 16 New Jersey (b) $623 51.2% $144.44 11.9% $434 35.7% $14.48 1.2% $1,216 4 $139.84 9 New Mexico (a, c) $22 46.8% NA NA $25 53.2% $46 51 $24.23 51 New York (b) $1,584 39.8% $506.50 12.7% $1,716 43.2% $171.00 4.3% $3,978 2 $206.21 3 North Carolina $309 30.1% $179.72 17.5% $486 47.3% $36.50 3.6% $16.88 1.6% $1,028 5 $119.82 14 North Dakota $19 40.8% $6.91 14.8% $21 44.3% $0.04 0.1% $47 50 $74.39 31 Ohio $207 27.3% $46.18 6.1% $475 62.7% $29.51 3.9% $758 11 $66.10 37 Oklahoma $63 40.2% $5.90 3.8% $78 49.6% $10.10 6.4% $157 37 $44.67 46 Oregon $119 27.3% $83.30 19.2% $89 20.5% $131.16 30.2% $12.41 2.9% $435 22 $119.48 15 Pennsylvania (a, c) $691 27.2% $35.95 1.4% $1,798 70.7% $16.79 0.7% $2,541 3 $204.92 4 Rhode Island (c) $29 28.5% $13.29 13.0% $58 56.8% $1.75 1.7% $102 44 $95.55 23 South Carolina $84 29.5% $38.50 13.5% $146 51.2% $1.40 0.5% $15.20 5.3% $285 26 $67.70 36 South Dakota $35 63.3% $20.21 36.7% $55 47 $71.38 35 Tennessee $246 47.1% $20.20 3.9% $243 46.5% $13.10 2.5% $522 19 $87.91 27 Texas $329 39.5% $20.00 2.4% $469.90 56.5% $13.60 1.6% $832 9 $36.47 49 Utahb $71 44.6% $42.95 26.9% $45 27.8% $1.10 0.7% $160 36 $64.34 39 Vermont $19 17.2% $17.60 16.1% $70 63.9% $3.10 2.8% $109 42 $175.16 5 Virginia $316 59.5% $48.10 9.0% $167 31.4% $532 18 $71.62 33 Washington (b) $226 38.6% $16.25 2.8% $328 56.1% $1.91 0.3% $12.77 2.2% $585 15 $93.96 24 West Virginia $48 40.5% $1.00 0.8% $70 58.6% $119 41 $65.56 38

Wisconsin (b) $227 39.1% $50.22 8.7% $301 52.0% $1.18 0.2% $580 16 $104.90 20

Wyoming $15 29.9% $6.91 13.8% $27 54.7% $0.81 1.6% $50 49 $98.79 21

Total $10,563 35.9% $2,951.19 10.0% $12,836 43.7% $2,400.49 8.2% $646.72 2.2% $29,397 $99.54 

Average (Mean) $207 $62.79 $252 $47.07 $12.68 $576 $103.43 

Median $119 $35.95 $85 $6.90 $285 $89.19 

(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.

Table 31: SMHA Mental Health Actual Dollar and per Capita Expenditures by State, FY 2005
Funding and Characteristics of State Mental Health Agencies, 2007 101

State Inpatient Percent

Other 

24-Hour 

Services

Percent

Less Than 

24-Hour 

Services

Percent Other Services Percent Research , Training, and Administration Percent SMHA- Expenditures Total Rank

Alabama $27.61 45.8% $7.32 12.1% $23.66 39.2% $0.00 0.0% $1.72 2.8% $60.31 42

Alaska $32.76 12.2% $100.72 37.4% $21.48 8.0% $107 $0 $7.50 2.8% $269.64 2

Arizona $25.81 17.7% $11.33 7.7% $106.84 73.1% $0 $0 $2.24 1.5% $146.22 8

Arkansas (a) $10.19 28.6% $10.41 29.2% $12.51 35.1% $0 $0 $2.49 7.0% $35.60 50

California (b) $30.57 25.8% $7.62 6.4% $69.10 58.2% $10.48 8.8% $0.88 0.7% $118.65 17Colorado $19.46 26.2% $0.66 0.9% $0.42 0.6% $53.46 72.0% $0.28 0.4% $74.28 32Connecticut(c) $58.91 37.5% $22.79 14.5% $60.08 38.2% $0 $0 $15.43 9.8% $157.21 6

Delaware (a, c) $49.53 55.5% $7.97 8.9% $29.76 33.4% $0 $0 $1.94 2.2% $89.19 26

District of Columbia (b) $138.82 34.3% $58.24 14.4% $170.59 42.2% $0 $0 $36.76 9.1% $404.40 1

Florida $21.78 59.6% $4.53 12.4% $9.57 26.2% $0 $0 $0.68 1.9% $36.56 48Georgia $22.31 45.5% NA NA $0.37 0.8% $26.30 53.7% $0.00 0.0% $48.98 45Hawaii $53.85 34.4% $38.10 24.3% $57.63 36.8% $0 $0 $7.08 4.5% $156.67 7

Idaho $16.10 42.6% $4.08 10.8% $17.63 46.6% $0.00 0.0% $0.00 0.0% $37.81 47Illinois $41.74 52.1% $7.74 9.7% $29.26 36.5% $0 $0 $1.42 1.8% $80.15 29Indiana $27.27 32.9% NA NA $0.00 0.0% $55.02 66.5% $0.50 0.6% $82.79 28Iowa $10.03 12.6% $14.86 18.7% $0.00 0.0% $53.24 67.0% $1.32 1.7% $79.44 30Kansas $25.13 27.1% NA NA $0.00 0.0% $67.68 72.9% $0.00 0.0% $92.81 25Kentucky $25.06 49.9% $5.19 10.3% $17.78 35.4% $0 $0 $2.20 4.4% $50.22 44Louisiana $33.71 58.5% $1.02 1.8% $19.03 33.0% $0 $0 $3.83 6.7% $57.59 43

Maine (a) $40.09 29.2% $8.06 5.9% $85.81 62.6% $0 $0 $3.19 2.3% $137.15 11

Maryland (b) $53.79 38.5% $20.84 14.9% $58.91 42.2% $0 $0 $6.21 4.4% $139.75 10Massachusetts (a) $30.17 28.3% $41.06 38.5% $32.20 30.2% $0 $0 $3.20 3.0% $106.64 18

Michigan (b) $33.13 34.4% $15.29 15.9% $47.26 49.0% $0 $0 $0.72 0.7% $96.40 22

Minnesota $53.91 41.3% $13.95 10.7% $62.05 47.5% $0 $0 $0.68 0.5% $130.60 13

Mississippi $57.82 54.7% $0.26 0.2% $2.47 2.3% $44.09 41.7% $1.05 1.0% $105.68 19Missouri $33.91 47.4% $6.41 9.0% $29.43 41.1% $0 $0 $1.84 2.6% $71.59 34Montana $27.89 20.8% $45.21 33.7% $56.73 42.3% $0 $0 $4.20 3.1% $134.03 12Nebraska $41.00 67.7% $2.57 4.2% $13.19 21.8% $2 $0 $1.80 3.0% $60.56 41Nevada $14.94 23.9% $10.86 17.3% $35.45 56.6% $0 $0 $1.37 2.2% $62.62 40

New Hampshire $37.92 32.0% $20.99 17.7% $49.78 42.0% $6.93 5.8% $3.02 2.5% $118.65 16

New Jersey (b) $71.62 51.2% $16.61 11.9% $49.95 35.7% $0 $0 $1.67 1.2% $139.84 9

New Mexico (a, c) $11.33 46.8% NA NA $12.90 53.2% $0 $0 $0.00 0.0% $24.23 51

New York (b) $82.10 39.8% $26.26 12.7% $88.98 43.2% $0 $0 $8.87 4.3% $206.21 3

North Carolina $36.03 30.1% $20.95 17.5% $56.62 47.3% $4.25 3.6% $1.97 1.6% $119.82 14North Dakota $30.37 40.8% $11.00 14.8% $32.96 44.3% $0 $0 $0.06 0.1% $74.39 31Ohio $18.05 27.3% $4.03 6.1% $41.45 62.7% $0 $0 $2.57 3.9% $66.10 37Oklahoma $17.98 40.2% $1.68 3.8% $22.15 49.6% $0 $0 $2.87 6.4% $44.67 46Oregon $32.60 27.3% $22.90 19.2% $24.50 20.5% $36.06 30.2% $3.41 2.9% $119.48 15

Pennsylvania (a, c) $55.69 27.2% $2.90 1.4% $144.98 70.7% $0 $0 $1.35 0.7% $204.92 4

Rhode Island (c) $27.27 28.5% $12.41 13.0% $54.23 56.8% $0 $0 $1.63 1.7% $95.55 23

South Carolina $19.99 29.5% $9.14 13.5% $34.63 51.2% $0 $0 $3.61 5.3% $67.70 36South Dakota $45.19 63.3% $26.19 36.7% $0.00 0.0% $0 $0 $0.00 0.0% $71.38 35Tennessee $41.40 47.1% $3.40 3.9% $40.91 46.5% $0 $0 $2.21 2.5% $87.91 27Texas (b) $14.41 39.5% $0.88 2.4% $0.00 0.0% $21 $1 $0.60 1.6% $36.47 49

Utah $28.70 44.6% $17.28 26.9% $17.91 27.8% $0 $0 $0.44 0.7% $64.34 39Vermont $30.05 17.2% $28.28 16.1% $111.84 63.9% $0 $0 $4.98 2.8% $175.16 5

Virginia (b) $42.62 59.5% $6.48 9.0% $22.52 31.4% $0 $0 $0.00 0.0% $71.62 33

Washington $36.28 38.6% $2.61 2.8% $52.72 56.1% $0.31 0.3% $2.05 2.2% $93.96 24

West Virginia (b) $26.58 40.5% $0.55 0.8% $38.43 58.6% $0.00 0.0% $0.00 0.0% $65.56 38

Wisconsin $41.06 39.1% $9.09 8.7% $54.53 52.0% $0 $0 $0.21 0.2% $104.90 20Wyoming $29.51 29.9% $13.66 13.8% $54.02 54.7% $0 $0 $1.60 1.6% $98.79 21Average (Mean) $35.77 35.9% $10.72 10.8% $49.41 49.6% $5.87 5.9% $2.39 2.4% $99.54

Median $30.57 34.3% $10.41 11.7% $32.96 37.0% $0.00 0.0% $1.72 1.9% $89.19

(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.

Table 32: SMHA Mental Health per Capita Expenditures for State Mental Hospitals, Community-Based Programs, and State Mental Health Support Activities by Type of Service Setting and by State, FY 2005 (in Millions)
102 Funding and Characteristics of State Mental Health Agencies, 2007 Table 33: SMHA-Controlled Mental Health Expenditures by Type of Program, FY 2005 (in Millions) State Prevention, Hospital Community- SMHA Total SMHA Total State Psychiatric Percent Rank Percent Research, and Rank Percent Rank Percent Rank Based Programs Administration Expenditures Rank Inpatient Training Alabama $125 23 46% $141 29 51% $0.00 $7.80 24 3% $274 27 Alaska $19 48 11% $149 28 86% $0.97 13 1% $3.86 27 2% $174 35 Arizona $63 32 7% $791 4 91% $1.00 12 0% $12.30 16 1% $867 8 Arkansas (a) $28 42 29% $64 44 64% $4.43 4 4% $2.47 34 3% $99 45 California (b) $764 2 18% $3,474 1 81% $0.00 $31.70 3 1% $4,270 1 Colorado $90 27 26% $252 21 73% $0.00 $1.30 39 0% $344 24 Connecticut(c) $168 18 31% $328 19 60% $12.80 2 2% $41.10 2 7% $549 17 Delaware (a, c) $39 39 52% $34 47 46% $0.00 $1.63 36 2% $75 46 District of Columbia (b) $80 29 34% $132 31 57% $0.00 $21.25 6 9% $234 31 Florida $287 8 44% $348 16 54% $0.00 $12.07 18 2% $647 14 Georgia $202 12 46% $242 22 54% $0.00 $0.00 $444 21 Hawaii $53 33 27% $131 32 68% $0.00 $8.70 22 5% $193 33 Idaho $23 45 43% $31 48 57% $0.00 $0.00 $54 48 Illinois $292 7 29% $711 8 70% $0.00 $18.10 7 2% $1,022 6 Indiana $171 17 33% $345 18 66% $0.88 14 0% $2.24 35 0% $519 20 Iowa $27 43 12% $204 25 87% $0.00 $3.92 26 2% $236 30 Kansas $69 30 27% $185 27 73% $0.00 $0.00 $254 29 Kentucky $104 25 50% $95 40 46% $0.00 $9.12 21 4% $208 32 Louisiana $135 22 52% $106 36 41% $0.00 $17.20 8 7% $259 28 Maine (a) $52 34 29% $124 33 69% $3.30 7 2% $0.90 42 0% $180 34 Maryland (b) $216 11 28% $526 11 68% $4.40 5 1% $30.10 4 4% $777 10 Massachusetts (a) $113 24 16% $552 9 81% $9.80 3 1% $10.80 19 2% $686 12 Michigan (b) $217 10 22% $749 7 77% $0.60 16 0% $6.70 25 1% $974 7 Minnesota $175 16 26% $491 13 73% $0.09 20 0% $3.38 29 1% $669 13 Mississippi $167 19 55% $136 30 44% $0.00 $3.04 33 1% $306 25 Missouri $194 14 47% $210 24 51% $0.00 $10.66 20 3% $414 23 Montana $21 47 17% $99 39 80% $0.14 19 0% $3.77 28 3% $125 40 Nebraska $63 31 59% $40 45 38% $1.70 10 2% $1.45 38 1% $106 43 Nevada $36 40 24% $111 35 74% $0.00 $3.30 31 2% $151 39 New Hampshire $48 36 31% $103 37 67% $0.63 15 0% $3.32 30 2% $155 38 New Jersey (b) $432 4 35% $770 5 63% $0.00 $14.48 10 1% $1,216 4 New Mexico (a, c) $22 46 47% $25 50 53% $0.00 $0.00 $46 51 New York (b) $1,073 1 27% $2,734 2 69% $65.60 1 2% $105.40 1 3% $3,978 2 North Carolina $261 9 25% $750 6 73% $0.00 $16.88 9 2% $1,028 5 North Dakota $19 49 40% $28 49 60% $0.00 $0.04 44 0% $47 50 Ohio $197 13 26% $531 10 70% $2.18 9 0% $27.33 5 4% $758 11 Oklahoma $45 38 29% $102 38 65% $1.40 11 1% $8.70 22 6% $157 37 Oregon $104 26 24% $318 20 73% $0.00 $12.41 15 3% $435 22 Pennsylvania (a, c) $492 3 19% $2,033 3 80% $3.50 6 0% $13.29 12 1% $2,541 3 Rhode Island (c) $26 44 26% $74 42 73% $0.18 18 0% $1.57 37 2% $102 44 South Carolina $82 28 29% $188 26 66% $2.30 8 1% $12.90 14 5% $285 26 South Dakota $35 41 63% $20 51 37% $0.00 $0.00 $55 47 Tennessee $164 20 31% $345 17 66% $0.00 $13.10 13 3% $522 19 Texas (b) $315 5 38% $504 12 61% $0.00 $13.60 11 2% $832 9 Utah $46 37 29% $113 34 71% na $1.10 41 1% $160 36 Vermont $15 50 14% $91 41 83% $0.00 $3.10 32 3% $109 42 Virginia (b) $308 6 58% $224 23 42% $0.00 $0.00 $532 18 Washington $177 15 30% $395 15 68% $0.52 17 0% $12.25 17 2% $585 15 West Virginia (b) $48 35 41% $71 43 59% $0.00 $0.00 $119 41

Wisconsin $161 21 28% $418 14 72% $0.00 $1.18 40 0% $580 16

Wyoming $15 51 30% $34 46 69% na $0.81 43 2% $50 49Total $8,077 27% $20,673 70% $116.42 0.4% $530.30 1.8% $29,397 

Average (Mean) $158 33% $405 65% $2.38 0.9% $10.40 2.4% $576 

Median $104 $188 $0.00 $3.92 $285 

Note: “Community services” include expenditures from state mental hospitals for ambulatory and residential services.(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.
Funding and Characteristics of State Mental Health Agencies, 2007 103

Table 34: SMHA Mental Health-Controlled per Capita Expenditures for State Mental Hospital Inpatient Services, Community Services Research, Training, and Administration: FY 2005

State

State 

Psychiatric 

Inpatient

Hospital 

Rank Percent Community- Based Programs Rank Percent Prevention, Research, and Training Rank Percent SMHA Administration Rank Percent Total SMHA Expenditures Total Rank

Alabama $27.61 25 46% $30.98 39 51% $1.72 22 3% $60.31 42

Alaska $30.04 19 11% $232.10 1 86% $1.51 6 1% $5.99 4 2% $269.64 2Arizona $10.55 49 7% $133.43 6 91% $0.17 15 0% $2.07 17 1% $146.22 8Arkansas (a) $10.19 50 29% $22.92 46 64% $1.60 4 4% $0.89 32 3% $35.60 50

California (b) $21.24 37 18% $96.53 9 81% $0.88 33 1% $118.65 17

Colorado $19.46 39 26% $54.53 29 73% $0.28 42 0% $74.28 32

Connecticut(c) $47.98 5 31% $93.80 13 60% $3.66 1 2% $11.76 2 7% $157.21 6

Delaware (a, c) $46.54 6 52% $40.72 36 46% $1.94 20 2% $89.19 26

District of Columbia (b) $138.82 1 34% $228.82 2 57% $36.76 1 9% $404.40 1

Florida $16.23 43 44% $19.66 50 54% $0.68 36 2% $36.56 48

Georgia $22.31 35 46% $26.67 42 54% $48.98 45Hawaii $42.86 8 27% $106.73 8 68% $7.08 3 5% $156.67 7

Idaho $16.10 44 43% $21.70 49 57% $37.81 47Illinois $22.93 34 29% $55.80 27 70% $1.42 27 2% $80.15 29

Indiana $27.27 27 33% $55.02 28 66% $0.14 17 0% $0.36 41 0% $82.79 28Iowa $9.22 51 12% $68.90 22 87% $1.32 29 2% $79.44 30

Kansas $25.13 29 27% $67.68 23 73% $92.81 25

Kentucky $25.06 30 50% $22.97 45 46% $2.20 16 4% $50.22 44

Louisiana $30.08 18 52% $23.68 44 41% $3.83 9 7% $57.59 43

Maine (a) $39.48 11 29% $94.48 12 69% $2.51 3 2% $0.68 35 0% $137.15 11

Maryland (b) $38.84 12 28% $94.70 11 68% $0.79 8 1% $5.42 6 4% $139.75 10

Massachusetts (a) $17.53 41 16% $85.90 17 81% $1.52 5 1% $1.68 23 2% $106.64 18

Michigan (b) $21.51 36 22% $74.17 20 77% $0.06 19 0% $0.66 37 1% $96.40 22

Minnesota $34.13 15 26% $95.79 10 73% $0.02 20 0% $0.66 38 1% $130.60 13

Mississippi $57.82 2 55% $46.81 30 44% $1.05 31 1% $105.68 19

Missouri $33.52 16 47% $36.23 38 51% $1.84 21 3% $71.59 34

Montana $23.07 33 17% $106.77 7 80% $0.15 16 0% $4.05 8 3% $134.03 12

Nebraska $35.92 14 59% $22.84 47 38% $0.97 7 2% $0.83 34 1% $60.56 41Nevada $14.94 45 24% $46.31 32 74% $1.37 28 2% $62.62 40

New Hampshire $36.50 13 31% $79.12 18 67% $0.48 10 0% $2.54 12 2% $118.65 16

New Jersey (b) $49.63 4 35% $88.55 14 63% $1.67 24 1% $139.84 9

New Mexico (a, c) $11.33 48 47% $12.90 51 53% $24.23 51

New York (b) $55.62 3 27% $141.72 5 69% $3.40 2 2% $5.46 5 3% $206.21 3

North Carolina $30.42 17 25% $87.43 16 73% $1.97 18 2% $119.82 14

North Dakota $29.80 20 40% $44.53 35 60% $0.06 44 0% $74.39 31

Ohio $17.16 42 26% $46.37 31 70% $0.19 13 0% $2.38 14 4% $66.10 37

Oklahoma $12.86 47 29% $28.94 41 65% $0.40 11 1% $2.47 13 6% $44.67 46Oregon $28.53 23 24% $87.54 15 73% $3.41 10 3% $119.48 15

Pennsylvania (a, c) $39.67 10 19% $163.90 3 80% $0.28 12 0% $1.07 30 1% $204.92 4

Rhode Island (c) $24.43 32 26% $69.48 21 73% $0.17 14 0% $1.46 26 2% $95.55 23

South Carolina $19.54 38 29% $44.55 34 66% $0.55 9 1% $3.06 11 5% $67.70 36South Dakota $45.19 7 63% $26.19 43 37% $71.38 35

Tennessee $27.57 26 31% $58.14 26 66% $2.21 15 3% $87.91 27

Texas (b) $13.81 46 38% $22.07 48 61% $0.60 39 2% $36.47 49

Utah $18.39 40 29% $45.51 33 71% NA NA $0.44 40 1% $64.34 39

Vermont $24.59 31 14% $145.59 4 83% $4.98 7 3% $175.16 5

Virginia (b) $41.45 9 58% $30.17 40 42% $71.62 33

Washington $28.45 24 30% $63.46 25 68% $0.08 18 0% $1.97 19 2% $93.96 24West Virginia (b) $26.58 28 41% $38.99 37 59% $65.56 38

Wisconsin $29.11 22 28% $75.57 19 72% $0.21 43 0% $104.90 20

Wyoming $29.51 21 30% $67.68 24 69% NA NA $1.60 25 2% $98.79 21

Average (Mean) $27.35 27% $70.00 70% $1.06 1% $1.96 2% $99.54 

Median $27.57 29% $58.14 68% $1.46 2% $89.19 

Note: “Community Services” include expenditures from state mental hospitals for ambulatory and residential services.(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.

(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.
104 Funding and Characteristics of State Mental Health Agencies, 2007 Table 35: SMHA Mental Health-Controlled Expenditures per Inpatient Day, All Civil (Voluntary and Involuntary) Patients in State Psychiatric Hospitals by Age and State, FY 2005 (in Millions) State Children and Adolescents Patient Days Expenditures Per Patient Rank Adult Patient Expenditures Per Patient Rank Total Civil Patients Patient Days Expenditures Per Patient Rank Alabama NA NA NA NA NA NA NA NA 369,268 $114.1 309.0 40 Alaska 3,201 $2.7 845.6 7 16,928 $14 845.2 1 20,129 $17.0 845.2 2 Arizona 2,298 $3.0 1,305.5 3 49,121 $27 541.5 13 51,419 $29.6 575.7 9 Arkansas (a) 7,700 $2.2 283.6 34 33,893 $21 628.2 4 41,593 $23.5 564.4 12 California (b) 11,268 $5.1 452.6 27 199,187 $91 454.3 28 210,455 $95.6 454.3 30 Colorado 11,871 $10.6 895.2 6 82,235 $39 468.8 25 94,106 $49.2 522.6 18 Connecticut (c) NA NA NA NA NA NA NA NA 96,265 $91.6 951.5 1 Delaware (a, c) NA NA NA NA 74,165 $34 452.9 29 74,165 $33.6 452.9 31 District of Columbia (b) NA NA NA NA 88,260 $50 563.1 10 88,260 $49.7 563.1 13 Florida NA NA NA NA 522,444 $160 307.0 39 522,444 $160.4 307.0 41 Georgia 34,654 $16.0 462.6 25 315,613 $159 503.2 21 350,267 $174.8 499.2 26 Hawaii NA NA NA NA NA NA NA NA NA NA NA NA Idaho 4,032 $2.2 542.6 22 38,997 $18 473.9 24 43,029 $20.7 480.4 28 Illinois 4,317 $2.5 579.1 21 289,420 $165 569.1 9 293,737 $167.2 569.2 10 Indiana 69,001 $30.4 439.9 28 250,304 $110 439.9 30 319,305 $140.5 439.9 33 Iowa 21,199 $7.5 353.2 31 59,942 $15 242.6 43 81,141 $22.0 271.5 44 Kansas 6,336 $5.2 820.7 8 95,881 $37 389.0 35 102,217 $42.5 415.8 35 Kentucky NA NA NA NA 180,892 $93 515.2 19 180,892 $93.2 515.2 20 Louisiana 26,710 $20.9 782.5 9 90,682 $39 433.4 31 117,392 $60.2 512.8 22 Maine (a) NA NA NA NA NA NA NA NA NA NA NA NA Maryland (b) 10,248 $4.7 458.6 26 241,707 $112 464.2 26 251,955 $116.9 464.0 29 Massachusetts (a) 10,921 $7.2 659.3 14 242,554 $136 560.3 11 253,475 $143.1 564.6 11 Michigan (b) NA NA NA NA NA NA NA NA NA NA NA NA Minnesota 17,304 $13.1 758.9 10 147,326 $84 569.9 8 164,630 $97.1 589.8 8 Mississippi 37,354 $17.6 472.2 24 563,075 $146 260.0 41 600,429 $164.0 273.2 42 Missouri 13,369 $12.6 943.4 5 156,353 $82 523.6 16 169,722 $94.5 556.7 14 Montana NA NA NA NA 51,706 $16 318.0 38 51,706 $16.4 318.0 39 Nebraska 6,205 $1.9 306.2 32 107,416 $41 381.7 37 113,621 $42.9 377.6 38 Nevada 19,024 $9.2 483.6 23 40,171 $21 525.3 15 59,195 $30.3 511.9 23 New Hampshire 5,690 $4.2 743.0 11 66,388 $43 654.2 3 72,078 $47.7 661.2 4 New Jersey (b) 9,855 $18.0 1,826.5 2 688,005 $331 481.7 23 697,860 $349.4 500.7 24 New Mexico (a, c) NA NA NA NA NA NA NA NA NA NA NA NA New York (b) 137,500 $134.2 976.0 4 1,541,200 $798 517.5 18 1,678,700 $931.7 555.0 15 North Carolina 40,351 $24.4 604.7 18 383,134 $231 601.9 7 423,485 $255.0 602.2 7 North Dakota 3,300 $1.2 358.8 30 69,869 $19 267.7 40 73,169 $19.9 271.8 43 Ohio NA NA NA NA 142,508 $69 486.7 22 142,508 $69.4 486.7 27 Oklahoma 11,019 $6.7 608.0 17 55,212 $22 403.9 34 66,231 $29.0 437.9 34 Oregon 263 $0.2 681.8 13 95,413 $51 536.5 14 95,676 $51.4 536.9 17 Pennsylvania (a, c) NA NA NA NA 832,328 $452 543.5 12 832,328 $452.4 543.5 16 Rhode Island (c) NA NA NA NA 31,215 $26 838.3 2 31,215 $26.2 838.3 3 South Carolina 14,411 $4.1 284.5 33 133,390 $55 409.3 32 147,801 $58.7 397.2 36 South Dakota 19,453 $4.7 239.5 35 74,542 $14 190.1 44 93,995 $18.8 200.3 46 Tennessee 5,523 $3.5 633.7 15 244,474 $125 510.5 20 249,997 $128.3 513.2 21 Texas (b) 74,283 $28.3 381.0 29 517,097 $199 383.9 36 591,380 $226.8 383.5 37 Utah 17,309 $10.3 595.1 19 57,685 $23 405.7 33 74,994 $33.7 449.4 32 Vermont NA NA NA NA NA $8 NA NA NA $7.7 NA NA Virginia (b) 12,296 $9.0 731.9 12 461,876 $280 605.8 6 474,172 $288.8 609.1 6

Washington 15,329 $9.0 588.5 20 524,656 $134 255.8 42 539,985 $143.2 265.2 45

West Virginia (b) NA NA NA NA 69,313 $36 517.9 17 69,313 $35.9 517.9 19

Wisconsin 31,234 $19.4 621.1 16 40,968 $26 624.9 5 72,202 $45.0 623.3 5

Wyoming 270 $0.8 2,867.4 1 16,521 $8 460.6 27 16,791 $8.4 499.3 25

Total 715,098 452.6 632.9 9,984,066 4,652 $466.69 11,164,697 5,318 $476.31

Average (Mean) 20,431 12.9 702.5 35 226,911 104 $480.15 44 242,711 113 $495.60 46

Median 11,871 7.2 604.7 101,649 50 $484.17 115,507 59 $506.27 

Minimum 263 0.2 239.5 16,521 8 $190.05 16,791 8 $200.28 

Maximum 137,500 134.2 2,867.4 1,541,200 798 $845.18 1,678,700 932 $951.54 

(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.
Funding and Characteristics of State Mental Health Agencies, 2007 105

Table 36: SMHA Mental Health-Controlled Expenditures per Inpatient Day, All Forensic Patients in State Psychiatric Hospitals Receiving Mental Health Services, by State, FY 2005 (in Millions)

Forensic Patients Sexually Violent Predators

State Patient Days Expenditures Per Patient Day Patient Days Expenditures Per Patient Day Total Forensic/ SVP Patient Days Expenditures Per Patient Rank

Alabama 41,422 $11.2 $270.39 NA $0 NA 41,422 $11 $270.39 37Alaska 2,763 $2.3 $839.70 NA $0 NA 2,763 $2 $839.70 1

Arizona 46,769 $23.4 $500.33 25,508 $10 $376.35 72,277 $33 $456.58 16Arkansas (a) 27,740 $4.8 $171.76 NA $0 NA 27,740 $5 $171.76 41

California (b) 1,270,185 $577.4 $454.58 201,133 $91 $454.43 1,471,318 $669 $454.56 18Colorado 88,574 $40.9 895.2 6 82,235 $39 468.8 25 94,106 $49.2 

Connecticut(c) $76.0 $461.72 NA NA NA 88,574 $41 $461.72 15 $91.6 

Delaware (a, c) 93,676 $811.31 NA $0 NA 93,676 $76 $811.31 2

District of Columbia (b) 10,191 $5.4 $532.00 NA $0 NA 10,191 $5 $532.00 9

Florida 75,796 $30.0 $395.24 1,460 $1 $409.57 77,256 $31 $395.51 24

Georgia 348,308 $105.0 $301.51 188,321 $22 $115.61 536,629 $127 $236.27 40

Hawaii 162,611 $27.4 $168.21 NA $0 NA 162,611 $27 $168.21 42Idaho NA NA NA NA NA NA NA NA NA NAIllinois 2,904 $1.4 $495.14 1,417 $1 $593.80 4,321 $2 $527.49 10Indiana 190,649 $107.7 $564.91 78,475 $17 $221.73 269,124 $125 $464.84 13Iowa 69,032 $30.4 $439.92 NA $0 NA 69,032 $30 $439.92 19Kansas 3,295 $1.7 $512.81 17,202 $4 $209.59 20,497 $5 $258.33 38Kentucky 38,949 $15.7 $403.09 44,530 $11 $235.80 83,479 $26 $313.85 31Louisiana 26,888 $10.8 $401.67 NA $0 NA 26,888 $11 $401.67 22Maine (a) 172,802 $74.8 $432.87 NA $0 NA 172,802 $75 $432.87 20

Maryland (b) NA $0.0 NA NA $0 NA NA NA NAMassachusetts (a) 213,160 $98.9 $463.97 NA $0 NA 213,160 $99 $463.97 14

Michigan (b) 91,156 $50.9 $558.38 NA $0 NA 91,156 $51 $558.38 7

Minnesota NA NA NA NA NA NA NA $0 NA NAMississippi 91,902 $47.3 $514.94 101,326 $30 $300.76 193,228 $78 $402.63 21

Missouri 11,678 $3.3 $285.44 NA $0 NA 11,678 $3 $285.44 33

Montana 258,265 $89.3 $345.74 36,201 $10 $277.63 294,466 $99 $337.37 27

Nebraska 15,834 $5.0 $318.04 NA NA NA 15,834 $5 $318.04 28

Nevada 44,778 $12.3 $274.69 26,645 $8 $288.98 71,423 $20 $280.02 34

New Hampshire 17,756 $5.6 $315.39 NA $0 NA 17,756 $6 $315.39 30

New Jersey (b) NA $0.0 NA NA $0 NA NA $0 NA NA

New Mexico (a, c) 145,290 $71.9 $494.87 114,975 $10 $88.71 260,265 $82 $315.45 29New York (b) 25,035 NA NA NA $0 NA 25,035 $0 NA NA

North Carolina 244,600 $141.2 $577.27 NA $0 NA 244,600 $141 $577.27 5

North Dakota 8,107 $6.0 $735.40 NA $0 NA 8,107 $6 $735.40 4

Ohio NA $0.0 NA 11,059 $1 $106.14 11,059 $1 $106.14 43Oklahoma 235,059 $127.4 $541.87 NA $0 NA 235,059 $127 $541.87 8

Oregon 58,591 $16.3 $278.20 NA $0 NA 58,591 $16 $278.20 35

Pennsylvania (a, c) 170,318 $52.4 $307.64 NA $0 NA 170,318 $52 $307.64 32

Rhode Island (c) 69,014 $39.5 $572.83 NA $0 NA 69,014 $40 $572.83 6

South Carolina NA NA NA NA $0 NA NA $0 NA NASouth Dakota 73,157 $19.7 $269.28 25,296 $4 $154.17 98,453 $24 $239.71 39

Tennessee NA $0.0 NA NA $0 NA NA $0 NA NATexas (b) 73,972 $35.4 $478.56 NA $0 NA 73,972 $35 $478.56 12

Utah 225,287 $88.2 $391.50 NA $0 NA 225,287 $88 $391.50 25

Vermont 30,059 $12.0 $399.21 NA $0 NA 30,059 $12 $399.21 23

Virginia (b) 16,766 $7.7 $456.28 NA $0 NA 16,766 $8 $456.28 17

Washington 64,571 $14.7 $227.66 3,879 $4 $1,056.97 68,450 $19 $274.65 36

West Virginia (b) 530,045 $34.1 $64.26 NA $0 NA 530,045 $34 $64.26 44

Wisconsin 25,187 $12.3 $488.35 NA $0 NA 25,187 $12 $488.35 11

Wyoming 233,171 $82.2 $352.53 103,585 $34 $325.34 336,756 $116 $344.17 26Total 8,579 $6.5 $762.41 NA $0 NA 8,579 $7 $762.41 3

Average (Mean) 5,653,891 2,226 $393.77 981,012 257 $261.99 6,634,903 2,483 $374.29 Median 128,498 47 $433.30 61,313 5 $325.97 147,442 51 $407.55 Minimum 69,023 20 $439.92 31,423 0 $283.31 72,277 24 $400.44 Maximum 2,763 0 $64.26 1,417 0 $88.71 2,763 0 $64.26 

1,270,185 577 $839.70 201,133 91 $1,056.97 1,471,318 669 $839.70 44

(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.

NA= Services provided but exact expenditures are unallocatable.
106 Funding and Characteristics of State Mental Health Agencies, 2007 Table 37: SMHA-Controlled Mental Health Revenues, by Revenue Source and by State, FY 2005 (in Millions) State State General Funds Percent State Medicaid Match Federal Medicaid Total Medicaid Percent Medicare Percent CMHS MHBG Percent Other Federal Percent Local Gov Percent 1st/3rd Party and Other Percent Total SMHA Revenues FY 2005 per Capita Alabama 157.9 58% 26.8 65.2 $92.0 34% $9.3 3% $6.7 2% $2.6 1% $0.0 0% $21.2 2% $273.7 $60.31 Alaska 31.4 18% 54.5 80.1 $134.6 78% $2.6 1% $0.8 0% $3.2 2% $0.0 0% $0.9 1% $173.5 $269.64 Arizona 134.0 16% 178.1 484.3 $662.4 78% $0.1 0% $7.7 1% $4.1 0% $0.0 0% $45.2 5% $853.5 $143.90 Arkansas (a) 60.5 61% 0.0 25.8 $25.8 26% $1.5 2% $3.5 4% $1.7 2% $0.0 0% $5.7 6% $98.6 $35.60 California (b) 1,632.6 38% 904.3 904.3 $1,808.6 42% $38.7 1% $54.5 1% $6.0 0% $0.0 0% $730.0 17% $4,270.4 $118.65 Colorado 146.5 43% 88.2 88.2 $176.3 51% $8.0 2% $5.2 2% $5.3 2% $0.0 0% $2.4 1% $343.8 $74.28 Connecticut(c) 528.0 91% 11.7 11.7 $23.4 4% $6.0 1% $5.2 1% $10.6 2% $0.0 0% $6.4 1% $579.6 $165.91 Delaware (a, c) 61.8 79% 6.8 8.1 $14.9 19% $0.2 0% $0.6 1% $0.3 0% $0.0 0% $0.0 0% $77.7 $92.73 District of Columbia (b) 193.1 83% 0.0 32.8 $32.8 14% $2.5 1% $0.8 0% $4.5 2% $0.0 0% $0.0 0% $233.8 $404.40 Florida 464.9 72% 46.8 72.6 $119.4 18% $0.0 0% $28.8 4% $34.0 5% $0.0 0% $0.0 0% $647.2 $36.56 Georgia 357.4 80% 49.7 5.6 $55.3 12% $8.4 2% $13.1 3% $9.8 2% $0.0 0% $0.0 0% $444.0 $48.98 Hawaii 184.7 95% 0.0 3.9 $3.9 2% $0.3 0% $1.7 1% $2.9 1% $0.0 0% $0.5 0% $194.1 $157.83 Idaho 37.4 64% 1.8 7.6 $9.4 16% $0.0 0% $1.8 3% $8.7 15% $0.0 0% $0.9 2% $58.3 $40.90 Illinois 591.7 58% 203.0 198.1 $401.1 39% $4.3 0% $16.9 2% $5.9 1% $0.0 0% $1.8 0% $1,021.7 $80.15 Indiana 105.2 20% 146.4 247.0 $393.4 76% $0.6 0% $7.6 1% $10.3 2% $0.0 0% $1.5 0% $518.7 $82.79 Iowa 78.2 33% 35.8 63.0 $98.8 41% $0.0 0% $3.7 2% $6.5 3% $52.7 22% $0.0 0% $239.8 $80.89 Kansas 92.0 36% 29.3 126.5 $155.8 61% $0.0 0% $2.7 1% $3.2 1% $0.0 0% $0.0 0% $253.7 $92.81 Kentucky 127.3 61% 17.5 42.6 $60.0 29% $9.9 5% $5.7 3% $3.1 1% $0.0 0% $2.4 1% $208.4 $50.22 Louisiana 110.7 43% 30.6 75.0 $105.6 41% $0.3 0% $5.2 2% $5.2 2% $0.0 0% $31.5 12% $258.5 $57.59 Maine (a) 49.3 27% 91.1 32.7 $123.8 69% $1.1 1% $1.8 1% $4.3 2% $0.0 0% $0.0 0% $180.3 $137.15 Maryland (b) 582.8 75% 0.0 181.0 $181.0 23% $0.0 0% $8.1 1% $4.6 1% $0.0 0% $0.0 0% $776.5 $139.75 Massachusetts (a) 672.8 82% 0.0 129.3 $129.3 16% $4.8 1% $8.5 1% $4.3 1% $0.0 0% $4.1 0% $823.8 $128.13 Michigan (b) 333.3 34% 246.4 354.5 $600.9 62% $4.0 0% $10.4 1% $0.5 0% $21.8 2% $2.6 0% $973.5 $96.40 Minnesota 276.6 41% 146.4 157.2 $303.6 45% $3.7 1% $6.3 1% $19.1 3% $32.6 5% $27.4 4% $669.3 $130.60 Mississippi 129.6 42% 36.0 120.9 $156.9 51% $0.0 0% $4.1 1% $3.7 1% $0.0 0% $11.6 4% $305.9 $105.68 Missouri 281.9 48% 42.2 224.0 $266.2 46% $12.9 2% $7.1 1% $11.2 2% $0.0 0% $3.3 1% $582.6 $100.75 Montana 38.5 31% 22.1 62.9 $85.0 68% $0.0 0% $1.0 1% $0.4 0% $0.0 0% $0.0 0% $124.8 $134.03 Nebraska 101.9 86% 0.0 9.9 $9.9 8% $0.9 NA $2.1 2% $2.3 2% $1.5 1% $0.0 0% $118.5 $67.65 Nevada 104.9 70% 10.2 12.5 $22.7 15% $3.7 2% $3.1 2% $9.8 7% $0.0 0% $6.3 4% $150.5 $62.62 New Hampshire 44.8 29% 45.5 45.5 $91.0 59% $6.6 4% $1.5 1% $5.2 3% $0.0 0% $5.7 4% $154.9 $118.65 New Jersey (b) 784.2 64% 115.1 115.1 $230.2 19% $48.8 4% $11.1 1% $2.2 0% $55.2 5% $84.1 7% $1,215.8 $139.84 New Mexico (a, c) 39.5 83% 1.1 3.5 $4.6 10% $0.2 0% $0.9 2% $0.2 0% $0.0 0% $2.3 5% $47.7 $24.91 New York (b) 1,058.4 28% 1,033.5 1,048.6 $2,082.1 56% $240.8 6% $28.9 1% $73.0 2% $69.2 2% $195.0 5% $3,747.4 $194.28 North Carolina 316.4 31% 203.5 413.7 $617.1 60% $28.2 3% $9.7 1% $2.6 0% $35.6 3% $18.1 2% $1,027.8 $119.82 North Dakota 22.2 47% 1.1 9.1 $10.2 22% $1.3 3% $0.8 2% $4.4 9% $0.0 0% $7.9 17% $46.8 $74.39 Ohio 433.0 54% 87.1 241.9 $329.0 41% $13.9 2% $15.3 2% $10.3 1% $0.0 0% $2.1 0% $803.5 $70.09 Oklahoma 121.1 77% 10.7 8.9 $19.6 12% $3.8 2% $4.9 3% $3.5 2% $0.0 0% $4.7 3% $157.6 $44.76 Oregon 122.6 28% 116.0 183.3 $299.3 69% $0.0 0% $4.4 1% $1.5 0% $0.0 NA $6.7 2% $434.6 $119.48 Pennsylvania(a, c) 1,613.8 64% 112.5 597.6 $710.1 28% $8.0 0% $17.4 1% $154.2 6% $0.0 0% $37.4 1% $2,540.8 $204.88 Rhode Island (c) 13.6 13% 38.4 48.0 $86.3 84% $0.0 0% $1.4 1% $1.1 1% $0.0 0% $0.0 0% $102.4 $95.55 South Carolina 106.9 38% 33.0 122.4 $155.4 55% $0.8 0% $5.9 2% $2.8 1% $3.0 1% $10.1 4% $284.9 $67.63 South Dakota 31.9 58% 6.6 12.6 $19.2 35% $2.1 4% $0.8 1% $0.9 2% $0.0 0% $0.3 0% $55.2 $71.47 Tennessee 144.2 28% 101.1 254.5 $355.6 68% $9.1 2% $8.1 2% $2.0 0% $0.0 0% $3.0 1% $522.0 $87.91 Texas (b) 523.9 63% 73.8 112.5 $186.3 22% $18.5 2% $33.0 4% $19.2 2% $19.3 2% $32.0 4% $832.2 $36.47 Utah 60.6 38% 0.0 83.2 $83.2 52% $1.5 1% $2.6 2% $2.9 2% $7.9 5% $1.2 1% $159.9 $64.34 Vermont 19.6 18% 34.2 51.5 $85.7 79% $0.4 0% $0.8 1% $2.3 2% $0.0 0% $0.2 0% $109.0 $175.16 Virginia (b) 352.9 64% 77.8 77.8 $155.6 28% $9.1 2% $9.7 2% $2.3 0% $0.0 0% $20.6 4% $550.2 $74.14 

Washington 54.1 9% 251.9 253.2 $505.1 86% $11.2 2% $8.1 1% $1.3 0% $0.0 0% $5.3 1% $585.2 $93.92 

West Virginia (b) 50.1 42% 11.0 33.1 $44.1 37% $2.9 2% $2.6 2% $18.4 15% $0.0 0% $0.8 1% $118.9 $65.56 

Wisconsin 305.8 53% 56.7 78.7 $135.5 23% $5.7 1% $6.8 1% $0.2 0% $113.6 20% $12.1 2% $579.7 $104.90 

Wyoming 43.2 83% 3.3 4.4 $7.7 15% $0.0 0% $0.4 1% $0.4 1% $0.0 0% $0.0 0% $51.8 $102.45 

Total $13,929.6 47% $4,839.5 $7,626.4 $12,465.9 42% $536.7 1.8% $400.1 1.4% $499.0 1.7% $412.4 1.4% $1,339.4 4.5% $29,583 $100.17 

Average (Mean) $273.1 $94.9 $149.5 $244.4 $10.5 $7.8 $9.8 $8.1 $26.3 0% $580 

Median $127.3 $36.0 $77.8 $123.8 $2.6 $5.2 $3.7 $0.0 $1.1 0% $285 $92.81 

(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.
Funding and Characteristics of State Mental Health Agencies, 2007 107

Table 38: SMHA-Controlled Mental Health Revenues to Community Programs, by Revenue Source and by State, FY 2005 (in Millions)

State

State 

General 

Funds

Percent

State 

Medicaid 

Match

Federal 

Medicaid

Total 

Medicaid Percent Medicare Percent CMHS MHBG Percent Other Federal Percent Local Gov Percent

1st/3rd 

Party 

and 

Other

Percent

Total 

SMHA 

Revenues

FY 

2005 

per 

Capita

Alabama 49.6 36% 22.7 55.1 $77.8 57% $0.0 0% $6.6 5% $2.5 2% $0.0 0% $0.4 0% $136.9 $30.16 

Alaska 22.2 15% 50.5 74.8 $125.3 84% $0.0 0% $0.8 1% $1.1 1% $0.0 0% $0.0 0% $149.4 $232.10 

Arizona 104.2 14% 164.7 453.8 $618.5 80% $0.0 0% $7.3 1% $1.8 0% $0.0 0% $38.6 5% $770.4 $129.89 

Arkansas (a) 32.5 88% 0.0 0.0 $0.0 0% $0.0 0% $3.4 9% $1.1 3% $0.0 0% $0.0 0% $37.0 $13.35 

California (b) 931.8 27% 895.1 895.1 $1,790.2 52% $38.7 1% $51.1 1% $6.0 0% $0.0 0% $656.4 19% $3,474.2 $96.53 

Colorado 72.7 29% 82.4 82.4 $164.8 66% $0.0 0% $4.8 2% $4.8 2% $0.0 0% $0.8 0% $247.9 $53.57 

Connecticut(c) 310.4 89% 8.9 8.9 $17.8 5% $1.5 0% $5.2 1% $9.4 3% $0.0 0% $2.9 1% $347.2 $99.39 

Delaware (a, c) 23.8 62% 6.8 6.8 $13.5 35% $0.2 0% $0.6 2% $0.3 1% $0.0 0% $0.0 0% $38.3 $45.74 

District of Columbia (b) 105.7 80% 0.0 23.9 $23.9 18% $0.0 0% $0.8 1% $1.9 1% $0.0 0% $0.0 0% $132.3 $228.82 

Florida 277.2 80% 8.5 8.5 $16.9 5% $0.0 0% $28.2 8% $25.6 7% $0.0 0% $0.0 0% $347.9 $19.66 

Georgia 163.6 68% 49.7 5.6 $55.3 23% $0.0 0% $13.1 5% $9.8 4% $0.0 0% $0.0 0% $241.8 $26.67 

Hawaii 130.9 95% 0.0 3.9 $3.9 3% $0.3 0% $1.7 1% $0.6 0% $0.0 0% $0.5 0% $138.0 $112.21 

Idaho 17.6 59% 1.3 1.8 $3.2 11% $0.0 0% $1.7 6% $6.9 23% $0.0 0% $0.4 1% $29.8 $20.90 

Illinois 300.5 42% 197.3 192.1 $389.4 55% $0.0 0% $16.1 2% $5.3 1% $0.0 0% $0.0 0% $711.3 $55.80 

Indiana 53.4 15% 104.2 172.2 $276.4 80% $0.0 0% $7.2 2% $7.7 2% $0.0 0% $0.0 0% $344.7 $55.02 

Iowa 46.4 23% 34.5 60.3 $94.8 48% $0.0 0% $3.5 2% $4.2 2% $49.7 25% $0.0 0% $198.6 $66.98 

Kansas 49.9 27% 29.3 99.9 $129.2 70% $0.0 0% $2.7 1% $3.2 2% $0.0 0% $0.0 0% $185.0 $67.68 

Kentucky 59.9 63% 7.0 18.9 $25.8 27% $0.0 0% $5.5 6% $2.7 3% NA $1.3 1% $95.3 $22.97 

Louisiana 67.2 68% 4.0 9.8 $13.8 14% $0.3 0% $3.5 4% $0.0 0% $0.0 0% $14.6 15% $99.4 $22.15 

Maine (a) 48.4 39% 73.7 0.0 $73.7 59% $0.0 0% $1.8 1% $0.3 0% $0.0 0% $0.0 0% $124.2 $94.48 

Maryland (b) 311.7 63% 0.0 170.4 $170.4 34% $0.0 0% $8.1 2% $4.4 1% $0.0 0% $0.0 0% $494.6 $89.02 

Massachusetts (a) 534.0 79% 0.0 120.6 $120.6 18% $4.1 1% $8.1 1% $4.1 1% $0.0 0% $3.5 1% $674.4 $104.90 

Michigan (b) 147.6 20% 240.1 340.8 $580.9 78% $0.0 0% $10.1 1% $0.2 0% $10.2 1% $0.0 0% $749.0 $74.17 

Minnesota 141.6 30% 137.5 148.4 $285.9 60% $0.0 0% $5.2 1% $18.8 4% $8.9 2% $15.2 3% $475.6 $92.80 

Mississippi 8.8 7% 25.7 86.4 $112.1 88% $0.0 0% $3.9 3% $2.8 2% $0.0 0% $0.0 0% $127.6 $44.09 

Missouri 60.0 30% 42.2 66.7 $108.9 55% $12.4 6% $6.9 3% $9.6 5% $0.0 0% $0.0 0% $197.8 $34.20 

Montana 13.8 14% 22.1 60.7 $82.8 85% $0.0 0% $1.0 1% $0.4 0% $0.0 0% $0.0 0% $97.9 $105.12 

Nebraska 43.5 87% 0.0 4.0 $4.0 8% $0.0 0% $2.0 4% $0.0 0% $0.6 1% $0.0 0% $50.1 $28.59 

Nevada 75.2 68% 7.7 9.4 $17.1 15% $0.4 0% $3.0 3% $9.4 8% $0.0 0% $6.2 6% $111.3 $46.31 

New Hampshire 4.1 5% 36.8 36.8 $73.6 85% $2.7 3% $1.5 2% $5.0 6% $0.0 0% $0.0 0% $86.9 $66.59 

New Jersey (b) 425.2 55% 99.2 99.2 $198.4 26% $26.6 3% $10.7 1% $1.5 0% $31.0 4% $76.4 10% $769.8 $88.55 

New Mexico (a, c) 20.1 95% 0.0 0.0 $0.0 0% $0.0 0% $0.9 4% $0.2 1% $0.0 0% $0.0 0% $21.2 $11.07 

New York (b) 467.0 22% 569.8 569.8 $1,139.6 54% $175.5 8% $27.6 1% $73.0 3% $44.4 2% $178.8 8% $2,105.9 $109.18 

North Carolina 100.5 14% 189.9 387.6 $577.4 80% $0.0 0% $9.7 1% $2.4 0% $33.5 5% $0.0 0% $723.5 $84.35 

North Dakota 9.8 38% 0.0 6.8 $6.8 27% $0.0 0% $0.8 3% $4.4 17% $0.0 0% $3.8 15% $25.7 $40.82 

Ohio 219.8 38% 86.8 240.5 $327.3 57% $0.0 0% $14.5 3% $10.3 2% $0.0 0% $0.0 0% $572.0 $49.90 

Oklahoma 76.7 75% 8.8 5.0 $13.8 14% $2.0 2% $4.6 5% $2.3 2% $0.0 0% $2.5 2% $101.9 $28.94 

Oregon 40.7 13% 105.1 167.6 $272.7 86% $0.0 0% $4.4 1% $0.4 0% $0.0 0% $0.1 0% $318.4 $87.54 

Pennsylvania(a, c) 1,191.3 59% 84.7 564.9 $649.6 32% $0.0 0% $17.4 1% $154.2 8% $0.0 0% $19.6 1% $2,032.1 $163.86 

Rhode Island (c) 12.4 17% 26.7 33.4 $60.2 81% $0.0 0% $1.4 2% $0.5 1% $0.0 0% $0.0 0% $74.4 $69.48 

South Carolina 43.4 25% 30.4 82.9 $113.3 64% $0.0 0% $5.9 3% $2.8 2% $3.0 2% $7.5 4% $175.9 $41.75 

South Dakota 7.6 38% 4.0 6.7 $10.7 54% $0.0 0% $0.8 4% $0.8 4% $0.0 0% $0.1 0% $19.9 $25.84 

Tennessee 38.4 11% 67.7 229.5 $297.2 86% $0.0 0% $7.7 2% $1.8 1% $0.0 0% $0.1 0% $345.2 $58.14 

Texas (b) 252.6 51% 61.9 95.0 $156.9 32% $0.0 0% $31.1 6% $17.3 4% $19.3 4% $17.0 3% $494.2 $21.66 

Utah 26.1 23% 0.0 74.0 $74.0 65% $0.0 0% $2.4 2% $2.7 2% $7.9 7% $0.0 0% $113.1 $45.51 

Vermont 4.3 5% 33.0 50.4 $83.4 92% $0.0 0% $0.8 1% $2.1 2% $0.0 0% $0.0 0% $90.6 $145.59 

Virginia (b) 112.4 50% 50.5 50.5 $101.0 45% $0.0 0% $9.7 4% $0.8 0% $0.0 0% $0.0 0% $223.9 $30.17 

Washington 30.1 8% 177.8 179.0 $356.8 90% $0.0 0% $7.7 2% $0.8 0% $0.0 0% $0.0 0% $395.4 $63.46 

West Virginia (b) 24.5 35% 11.0 32.4 $43.4 61% $0.0 0% $2.6 4% $0.2 0% $0.0 0% $0.0 0% $70.7 $38.99 

Wisconsin 176.4 42% 50.6 70.3 $120.8 29% $0.0 0% $6.8 2% $0.0 0% $113.6 27% $0.0 0% $417.6 $75.57 

Wyoming 18.2 68% 3.2 4.4 $7.7 29% $0.0 0% $0.4 2% $0.4 2% $0.0 0% $0.0 0% $26.7 $52.79 

Total $7,505.6 37% $3,913.6 $6,167.8 $10,081.4 50% $264.8 1.3% $383.5 1.9% $428.9 2.1% $322.1 1.6% $1,046.8 3.8% $20,033 $67.84 

Average (Mean) $147.2 $76.7 $120.9 $197.7 $5.2 $7.5 $8.4 $6.4 $20.5 0.0% $393 

Median $59.9 $30.4 $60.7 $94.8 $0.0 $4.8 $2.5 $0.0 $0.0 0.0% $185 $55.80

(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.
108 Funding and Characteristics of State Mental Health Agencies, 2007

Table 39: SMHA-Controlled Mental Health Medicaid Revenues as a Percentage of Total State 

Medicaid Spending, by State, FY 2005

State State Medicaid 

Match

Federal 

Medicaid

Total SMHA 

Mental Health 

Medicaid

Percent

Total State 

Medicaid 

Expenditures

Alabama 26,800,000 65,200,000 92,000,000 2.3% $4,062,000,000 

Alaska 54,526,100 80,065,300 134,591,400 13.1% $1,027,000,000 

Arizona 178,100,000 484,300,000 662,400,000 14.9% $4,443,000,000 

Arkansas (a) 0 25,778,175 25,778,175 0.9% $3,007,000,000 

California (b) 904,300,000 904,300,000 1,808,600,000 5.5% $32,907,000,000 

Colorado 88,174,156 88,174,156 176,348,312 7.0% $2,508,000,000 

Connecticut(c) 11,700,000 11,700,000 23,400,000 0.6% $3,716,000,000 

Delaware (a, c) 6,754,621 8,114,421 14,869,041 1.6% $917,000,000 

District of Columbia (b) 0 32,838,143 32,838,143 2.6% $1,276,605,955 

Florida 46,842,518 72,561,761 119,404,279 0.9% $13,890,000,000 

Georgia 49,716,516 5,603,124 55,319,640 0.9% $6,470,000,000 

Hawaii 0 3,900,000 3,900,000 0.4% $912,000,000 

Idaho 1,787,300 7,602,000 9,389,300 0.9% $1,053,000,000 

Illinois 203,000,000 198,100,000 401,100,000 3.4% $11,834,000,000 

Indiana 146,412,871 247,028,240 393,441,111 8.7% $4,510,000,000 

Iowa 35,761,240 62,993,584 98,754,824 4.2% $2,334,000,000 

Kansas 29,300,000 126,500,000 155,800,000 7.2% $2,162,000,000 

Kentucky 17,478,800 42,551,500 60,030,300 1.4% $4,249,000,000 

Louisiana 30,600,000 75,000,000 105,600,000 2.1% $5,066,000,000 

Maine (a) 91,100,000 32,700,000 123,800,000 5.9% $2,099,000,000 

Maryland (b) 0 181,000,000 181,000,000 3.5% $5,167,000,000 

Massachusetts (a) 0 129,300,000 129,300,000 2.2% $5,998,000,000 

Michigan (b) 246,400,000 354,500,000 600,900,000 6.9% $8,687,000,000 

Minnesota 146,362,857 157,247,177 303,610,034 5.7% $5,312,000,000 

Mississippi 35,992,617 120,886,796 156,879,413 4.3% $3,637,000,000 

Missouri 42,218,067 223,963,205 266,181,272 4.1% $6,561,000,000 

Montana 22,055,823 62,908,814 84,964,637 12.4% $683,000,000 

Nebraska 0 9,900,000 9,900,000 0.7% $1,431,000,000 

Nevada 10,200,000 12,500,000 22,700,000 2.0% $1,143,000,000 

New Hampshire 45,511,433 45,511,433 91,022,866 7.5% $1,219,000,000 

New Jersey (b) 115,097,000 115,097,000 230,194,000 3.0% $7,568,000,000 

New Mexico (a, c) 1,100,000 3,500,000 4,600,000 0.2% $2,401,000,000 

New York (b) 1,033,500,000 1,048,600,000 2,082,100,000 7.1% $29,355,000,000 

North Carolina 203,455,582 413,674,823 617,130,405 7.3% $8,489,000,000 

North Dakota 1,101,680 9,139,075 10,240,755 2.0% $513,000,000 

Ohio 87,108,088 241,908,079 329,016,167 2.6% $12,564,000,000 

Oklahoma 10,700,000 8,900,000 19,600,000 0.7% $2,735,000,000 

Oregon 115,988,082 183,320,297 299,308,379 9.4% $3,192,000,000 

Pennsylvania (a, c) 112,487,483 597,605,376 710,092,859 4.3% $16,638,000,000 

Rhode Island (c) 38,377,310 47,950,949 86,328,259 5.2% $1,662,000,000 

South Carolina 33,000,000 122,400,000 155,400,000 3.6% $4,318,000,000 

South Dakota 6,621,998 12,612,632 19,234,630 3.1% $628,000,000 

Tennessee 101,100,000 254,500,000 355,600,000 4.1% $8,570,000,000 

Texas (b) 73,800,000 112,500,000 186,300,000 1.1% $17,713,000,000 

Utah 0 83,233,100 83,233,100 6.0% $1,393,000,000 

Vermont 34,200,000 51,500,000 85,700,000 10.1% $849,000,000 

Virginia (b) 77,800,000 77,800,000 155,600,000 3.6% $4,309,000,000 

Washington 251,904,979 253,179,755 505,084,734 8.2% $6,161,000,000 

West Virginia (b) 11,000,000 33,100,000 44,100,000 2.1% $2,088,000,000 

Wisconsin 56,728,729 78,723,945 135,452,674 3.1% $4,384,000,000 

Wyoming 3,293,651 4,429,351 7,723,002 1.8% $427,000,000 

Total $4,839,459,501 $7,626,402,210 $12,465,861,711 4.4% $284,237,605,955 

Average (Mean) $94,891,363 $149,537,298 $244,428,661 4.4% $5,573,286,391 

Median $35,992,617 $77,800,000 $123,800,000 3.5% $3,716,000,000 

Number of States Reporting 51 51 51

Note: Total state government Medicaid data from NASBO Fiscal Survey of the States, FY 2005; DC data from CMS

(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.

(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.

(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.
Funding and Characteristics of State Mental Health Agencies, 2007 109

Table 40: FY 2001 to FY 2005 SMHA-Controlled Mental Health Expenditures (in Millions)

State State Psychiatric Hospital Inpatient Community Mental Health Total SMHA-Con trolled

FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005

Alabama $103.6 $107.4 $105.0 $112.5 $125.3 $142.6 $152.7 $161.9 $146.3 $140.6 $253.3 $267.9 $273.6 $265.6 $273.7

Alaska $17.1 $17.2 $18.0 $18.7 $19.3 $31.2 $21.7 $32.1 $158.5 $149.4 $51.4 $54.9 $53.6 $182.7 $173.5

Arizona $46.4 $55.8 $61.5 $63.1 $62.6 $415.4 $485.4 $626.5 $700.1 $791.4 $472.3 $553.2 $702.3 $776.0 $867.3

Arkansas (a) $23.2 $25.3 $25.6 $26.6 $28.2 $49.2 $48.4 $50.2 $58.6 $63.5 $75.7 $76.4 $80.5 $90.5 $98.6

California (b) $569.5 $625.9 $631.1 $699.7 $764.4 $2,546.4 $2,997.2 $3,199.3 $3,327.6 $3,474.1 $3,147.8 $3,656.3 $3,861.7 $4,060.3 $4,270.2

Colorado $83.6 $92.0 $79.5 $72.1 $90.1 $197.6 $207.7 $218.3 $241.8 $252.4 $282.6 $301.2 $299.5 $315.6 $343.8

Connecticut (c) $133.5 $140.1 $138.7 $146.2 $167.6 $267.3 $294.4 $334.6 $333.8 $327.7 $439.5 $478.2 $525.0 $531.7 $549.2

Delaware (a, c) $47.4 $44.6 $36.5 $37.2 $39.0 $24.6 $24.7 $28.7 $31.6 $34.1 $73.5 $69.3 $66.2 $70.2 $74.8

District of Columbia (b) $103.3 $79.5 $77.5 $80.8 $80.3 $123.3 $122.4 $128.5 $119.0 $132.3 $226.6 $231.8 $231.5 $225.3 $233.8

Florida $252.0 $390.5 $275.4 $275.1 $287.2 $316.0 $336.2 $357.5 $336.6 $347.9 $578.3 $736.3 $643.9 $623.1 $647.2

Georgia $173.6 $180.2 $189.0 $192.9 $202.2 $184.9 $206.6 $226.5 $240.5 $241.8 $380.6 $399.1 $429.6 $448.7 $444.0

Hawaii $33.8 $36.6 $42.9 $50.0 $52.7 $152.5 $140.3 $96.3 $110.1 $131.2 $213.6 $194.3 $152.1 $180.3 $192.6

Idaho $22.0 $19.9 $19.1 $18.8 $22.9 $37.4 $28.8 $24.6 $32.6 $30.9 $60.5 $53.5 $45.9 $54.9 $53.9

Illinois $306.7 $280.4 $256.8 $255.5 $292.3 $465.7 $566.3 $555.8 $595.5 $711.3 $789.9 $865.2 $835.1 $869.5 $1,021.7

Indiana $146.9 $148.5 $143.7 $159.8 $170.8 $261.2 $274.6 $301.1 $339.4 $344.7 $411.9 $427.3 $448.3 $502.5 $518.7

Iowa $36.1 $37.7 $29.0 $30.1 $27.3 $115.7 $118.7 $183.5 $190.2 $204.3 $152.4 $157.0 $217.0 $224.9 $235.6

Kansas $57.4 $58.1 $58.4 $62.9 $68.7 $102.0 $130.9 $145.2 $163.3 $185.0 $161.8 $189.0 $203.6 $226.2 $253.7

Kentucky $100.7 $102.6 $99.2 $99.1 $104.0 $92.5 $101.3 $102.5 $97.8 $95.3 $196.9 $207.1 $210.0 $205.0 $208.4

Louisiana $116.2 $130.1 $122.8 $122.7 $135.0 $80.7 $76.4 $96.8 $103.4 $106.3 $200.9 $214.8 $229.8 $236.6 $258.5

Maine (a) $41.3 $49.4 $51.5 $52.5 $51.9 $89.6 $96.5 $111.7 $114.4 $124.2 $137.5 $152.5 $166.5 $171.6 $180.3

Maryland (b) $203.5 $216.6 $221.8 $218.3 $215.8 $444.4 $491.6 $549.5 $578.0 $526.2 $677.8 $739.5 $805.0 $828.5 $776.5

Massachusetts (a) $122.7 $125.9 $121.9 $107.4 $112.7 $538.4 $542.8 $540.3 $539.2 $552.3 $682.2 $689.6 $682.8 $666.8 $685.6

Michigan (b) $295.2 $281.0 $253.6 $235.2 $217.2 $540.1 $626.8 $725.1 $676.3 $749.0 $844.4 $915.8 $985.5 $919.6 $973.5

Minnesota $154.8 $157.7 $174.0 $166.0 $174.9 $359.9 $415.9 $452.2 $470.0 $490.9 $518.0 $576.6 $629.4 $639.0 $669.3

Mississippi $147.2 $143.8 $150.4 $152.8 $167.4 $96.7 $109.0 $114.6 $119.9 $135.5 $246.8 $255.5 $267.8 $275.7 $305.9

Missouri $169.5 $162.2 $181.4 $192.6 $193.8 $151.4 $216.9 $191.2 $194.8 $209.5 $336.2 $390.9 $382.8 $397.8 $414.0

Montana $19.4 $18.0 $18.3 $20.1 $21.5 $88.4 $98.2 $92.1 $94.1 $99.4 $111.7 $119.4 $112.8 $117.6 $124.8

Nebraska $54.9 $55.9 $62.5 $62.2 $62.9 $30.1 $37.4 $36.2 $36.7 $40.0 $86.6 $95.7 $100.9 $101.4 $106.1

Nevada $43.5 $39.2 $39.4 $30.5 $35.9 $75.6 $88.3 $98.1 $93.5 $111.3 $120.2 $128.7 $140.1 $126.6 $150.5

New Hampshire $41.5 $44.0 $45.5 $46.3 $47.7 $96.4 $99.6 $101.2 $102.0 $103.3 $140.5 $147.2 $150.8 $152.2 $154.9

New Jersey (b) $297.0 $337.7 $364.5 $404.0 $431.5 $452.8 $674.6 $705.9 $741.8 $769.8 $763.1 $1,025.5 $1,083.9 $1,159.5 $1,215.8

New Mexico (a, c) $21.9 $21.5 $22.1 $18.4 $21.7 $36.8 $31.4 $31.6 $34.2 $24.7 $59.0 $53.0 $53.7 $52.5 $46.4

New York (b) $992.6 $1,052.8 $1,045.5 $1,056.4 $1,072.9 $2,210.2 $2,327.6 $2,479.4 $2,619.2 $2,733.6 $3,331.7 $3,526.8 $3,681.4 $3,840.9 $3,977.5

North Carolina $300.1 $284.0 $273.5 $253.7 $261.0 $139.5 $121.9 $141.7 $724.9 $749.9 $442.7 $408.4 $417.3 $994.2 $1,027.8

North Dakota $22.4 $23.8 $23.1 $19.2 $18.7 $26.8 $27.4 $27.7 $26.7 $28.0 $49.9 $51.3 $50.8 $45.9 $46.8

Ohio $193.8 $188.3 $185.4 $189.9 $196.7 $469.7 $481.7 $494.8 $514.6 $531.5 $692.3 $698.7 $708.9 $733.5 $757.7

Oklahoma $40.7 $44.1 $43.9 $42.3 $45.3 $87.5 $90.9 $86.0 $88.4 $101.9 $136.1 $142.4 $137.5 $139.2 $157.3

Oregon $81.0 $89.9 $79.5 $96.0 $103.8 $115.8 $115.1 $117.1 $118.4 $318.4 $201.9 $209.5 $201.0 $218.4 $434.6

Pennsylvania (a, c) $399.1 $398.7 $399.3 $408.7 $491.9 $1,447.1 $1,638.5 $1,993.6 $1,887.0 $2,032.6 $1,859.8 $2,052.8 $2,410.5 $2,312.5 $2,541.3

Rhode Island (c) $23.7 $23.0 $23.9 $24.4 $26.2 $66.7 $69.4 $69.5 $74.0 $74.4 $92.5 $94.4 $95.3 $100.1 $102.4

South Carolina $108.8 $101.5 $86.0 $80.1 $82.3 $174.2 $164.5 $173.8 $183.0 $187.7 $299.4 $283.0 $276.1 $280.1 $285.2

South Dakota $30.6 $31.2 $32.5 $33.4 $34.9 $14.3 $17.6 $17.6 $19.1 $20.2 $45.7 $49.4 $50.1 $53.3 $55.1

Tennessee $126.8 $137.8 $148.5 $155.3 $163.7 $257.7 $338.4 $346.8 $350.5 $345.2 $395.2 $486.5 $508.0 $518.7 $522.0

Texas (b) $306.2 $325.6 $351.0 $330.6 $315.0 $462.4 $479.5 $479.5 $475.4 $503.6 $797.0 $833.0 $858.2 $821.0 $832.2

Utah $41.3 $41.1 $40.1 $42.9 $45.7 $116.9 $118.1 $125.1 $131.2 $113.1 $159.3 $159.2 $166.4 $175.3 $159.9

Vermont $9.6 $10.5 $12.3 $12.8 $15.3 $67.9 $76.1 $79.4 $87.1 $90.6 $79.7 $89.2 $94.3 $103.1 $109.0

Virginia (b) $277.7 $275.9 $290.1 $293.5 $307.6 $162.8 $179.8 $189.6 $202.4 $223.9 $466.6 $479.6 $495.6 $509.8 $531.5

Washington $167.9 $173.1 $171.7 $170.9 $177.3 $345.7 $368.6 $368.0 $392.2 $395.4 $525.6 $554.5 $552.8 $575.3 $585.5

West Virginia (b) $36.9 $44.5 $48.1 $50.1 $48.2 $48.5 $38.8 $39.5 $58.4 $70.7 $87.1 $83.9 $88.2 $108.5 $118.9

Wisconsin $109.7 $160.2 $170.5 $151.1 $160.9 $293.5 $331.1 $325.7 $369.6 $417.6 $405.4 $492.7 $497.8 $522.3 $579.7

Wyoming $13.1 $13.6 $15.1 $16.6 $14.9 $16.2 $24.4 $35.6 $34.2 $34.2 $30.1 $38.4 $51.4 $51.5 $50.0

Total** $7,267 $7,645 $7,557 $7,658 $8,077 $15,130 $16,873 $18,210 $19,478 $20,673 $22,991 $25,156 $26,413 $27,802 $29,397 

Mediian $103 $102 $86 $96 $104 $140 $131 $145 $163 $188 $247 $256 $268 $266 $285 

Average $142 $150 $148 $150 $158 $297 $331 $357 $382 $405 $451 $493 $518 $545 $576 

State Reporting 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 

**Total percent changes are calculated based only on states reporting data for both years being compared.(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.
110 Funding and Characteristics of State Mental Health Agencies, 2007

Table 41: FY 2001 to FY 2005 Percent Change in SMHA-Controlled Mental Health 

Expenditures

State

Average Annual FY 2001 to FY 2005 FY 2004 to FY 2005

Hospital Community Total Hospital Community Total

Alabama 4.9% -0.3% 2.0% 11.4% -3.9% 3.0%

Alaska 3.1% 48.0% 35.5% 3.7% -5.8% -5.0%

Arizona 7.8% 17.5% 16.4% -0.8% 13.0% 11.8%

Arkansas (a) 5.0% 6.6% 6.8% 6.3% 8.3% 9.0%

California (b) 7.6% 8.1% 7.9% 9.2% 4.4% 5.2%

Colorado 1.9% 6.3% 5.0% 25.0% 4.4% 8.9%

Connecticut(c) 5.9% 5.2% 5.7% 14.6% -1.8% 3.3%

Delaware (a, c) -4.8% 8.5% 0.4% 4.8% 8.1% 6.6%

District of Columbia (b) -6.1% 1.8% 0.8% -0.7% 11.2% 3.8%

Florida 3.3% 2.4% 2.9% 4.4% 3.3% 3.9%

Georgia 3.9% 6.9% 3.9% 4.8% 0.5% -1.0%

Hawaii 11.7% -3.7% -2.6% 5.4% 19.2% 6.8%

Idaho 1.0% -4.7% -2.9% 22.1% -5.2% -1.9%

Illinois -1.2% 11.2% 6.6% 14.4% 19.4% 17.5%

Indiana 3.9% 7.2% 5.9% 6.9% 1.6% 3.2%

Iowa -6.7% 15.3% 11.5% -9.1% 7.4% 4.7%

Kansas 4.6% 16.1% 11.9% 9.2% 13.3% 12.2%

Kentucky 0.8% 0.8% 1.4% 4.9% -2.5% 1.7%

Louisiana 3.8% 7.1% 6.5% 10.0% 2.8% 9.3%

Maine (a) 5.9% 8.5% 7.0% -1.1% 8.6% 5.1%

Maryland (b) 1.5% 4.3% 3.5% -1.1% -9.0% -6.3%

Massachusetts (a) -2.1% 0.6% 0.1% 4.9% 2.4% 2.8%

Michigan (b) -7.4% 8.5% 3.6% -7.7% 10.7% 5.9%

Minnesota 3.1% 8.1% 6.6% 5.4% 4.5% 4.7%

Mississippi 3.3% 8.8% 5.5% 9.5% 13.0% 11.0%

Missouri 3.4% 8.5% 5.3% 0.6% 7.5% 4.1%

Montana 2.6% 3.0% 2.8% 7.1% 5.6% 6.2%

Nebraska 3.5% 7.4% 5.2% 1.1% 9.0% 4.6%

Nevada -4.7% 10.1% 5.8% 17.7% 19.1% 18.9%

New Hampshire 3.5% 1.8% 2.5% 3.0% 1.3% 1.8%

New Jersey (b) 9.8% 14.2% 12.4% 6.8% 3.8% 4.9%

New Mexico (a, c) -0.2% -9.5% -5.8% 18.2% -27.7% -11.7%

New York (b) 2.0% 5.5% 4.5% 1.6% 4.4% 3.6%

North Carolina -3.4% 52.3% 23.4% 2.9% 3.5% 3.4%

North Dakota -4.4% 1.1% -1.6% -2.4% 5.0% 1.9%

Ohio 0.4% 3.1% 2.3% 3.6% 3.3% 3.3%

Oklahoma 2.7% 3.9% 3.7% 7.1% 15.3% 13.0%

Oregon 6.4% 28.8% 21.1% 8.1% 168.9% 99.0%

Pennsylvania (a, c) 5.4% 8.9% 8.1% 20.4% 7.7% 9.9%

Rhode Island (c) 2.5% 2.8% 2.6% 7.0% 0.6% 2.2%

South Carolina -6.7% 1.9% -1.2% 2.7% 2.6% 1.8%

South Dakota 3.3% 9.0% 4.8% 4.4% 5.5% 3.4%

Tennessee 6.6% 7.6% 7.2% 5.4% -1.5% 0.6%

Texas (b) 0.7% 2.2% 1.1% -4.7% 5.9% 1.4%

Utah 2.6% -0.8% 0.1% 6.5% -13.8% -8.8%

Vermont 12.4% 7.5% 8.2% 19.5% 4.0% 5.7%

Virginia (b) 2.6% 8.3% 3.3% 4.8% 10.6% 4.3%

Washington 1.4% 3.4% 2.7% 3.7% 0.8% 1.8%

West Virginia (b) 6.9% 9.9% 8.1% -3.8% 21.1% 9.6%

Wisconsin 10.0% 9.2% 9.4% 6.5% 13.0% 11.0%

Wyoming 3.4% 20.6% 13.5% -9.9% 0.0% -3.1%

Total** 3.6% 11.0% 8.5% 5.5% 6.1% 5.7%

Median 3.1% 7.2% 5.0% 4.9% 4.4% 4.1%

Average 2.5% 8.2% 5.9% 5.8% 7.9% 6.2%

States Reporting 51 51 51 51 51 51 

States Increasing 40 46 46 41 42 44 

States Decreasing 11 5 5 10 9 7 

**Total percent changes are calculated based only on states reporting data for both years being compared.

(a) Medicaid revenues for community programs are not included in SMHA-controlled expenditures.

(b) SMHA-controlled expenditures include funds for mental health services in jails or prisons.

(c) Children’s mental health expenditures are not included in SMHA-controlled expenditures.
IX.

Funding and Characteristics of State Mental Health Agencies, 2007 111

The SMHA and 

its Relationship 

With Other State 

Government Agencies

This section discusses the SMHA’s relationship with other state 

government agencies and highlights some interagency collaboration 

the SMHA is engaged in. In recent years, SMHAs have advanced the 

importance of interagency collaboration by taking steps to better understand 

the role of other state agencies in delivering mental health services and 

supports. The PNFC found that the provision of mental health services 

and essential supports (such as housing and vocational rehabilitation) 

are being provided by a broad array of state government agencies. The 

level of coordination among these agencies, however, does not deter the 

Commission’s conclusion that the provision of mental health services is 

highly fragmented, leaving clients to navigate through a complicated maze 

to receive high quality of care.

provide $2.3 billion in funding for state 

psychiatric hospitals (26 percent of state 

psychiatric hospital funding).

Since then, SMHAs have taken the 

challenge through a number of activities to 

break silos, address the fragmentation issue, 

and better understand the overall state 

delivery of mental health care. Through 

analysis of Medicaid-paid claims files, 

linking of SMHA data with other state 

agencies, and participation in special 

projects that strengthen interagency 

collaboration, the relationship between the 

SMHA and other state agencies seems to be 

moving towards the direction essential to 

designing an effective and efficient service 

delivery system. 

The succeeding paragraphs illustrate the 

extent to which SMHAs implement these 

various initiatives.

9.1 Analysis of Medicaid-Paid 

Claims Files

Forty-four states reported they have 

access to Medicaid-paid claims files. In 30 

states, the SMHA analyzes mental health 

services paid for by Medicaid. A few 

methods facilitate the conduct of analysis. In 
112 Funding and Characteristics of State Mental Health Agencies, 2007

12 states (Colorado, Iowa, Illinois, 

Louisiana, Maine, Michigan, Nebraska, New 

York, Pennsylvania, South Carolina, 

Tennessee, and Wisconsin), the SMHA 

utilizes a central data warehouse run by a 

separate agency that combines SMHA data 

with Medicaid data. In 22 states, the SMHA 

uses a direct link to a paid claims contractor 

database. Medicaid-paid claims data were 

reported not linked to mental health data in 

only 10 SMHAs. 

Of the states that link Medicaid-paid 

claims data, 14 perform the linking on a 

monthly basis, and 7 link data on an ad hoc 

basis. There were several reasons cited by 

SMHAs for linking Medicaid and mental 

health data:

■ Analysis of mental health services (36 

states)

■ Linking for administrative purposes (28 

states)

■ Linking for policy analysis (29 states)

■ Linking to identify fraud and abuse (11 

states)

To further sustain the effort to understand 

mental health expenditures of other state 

agencies, 14 SMHAs are working with their 

state Medicaid agency to combine data 

systems. Seven states are considering the use 

of the Federal Centers for Medicare and 

Medicaid Systems’ (CMS) Medicaid 

Information Technology Architecture 

(MITA) for the integrated system. For 

example, Oklahoma has been developing a 

new information system around the MITA 

standards, while in Indiana, Maryland, 

Missouri, Ohio, and Rhode Island, the 

SMHA and Medicaid agency are exploring 

potential MITA-related collaborations to 

their data systems.

9.2 Linking SMHA Data With Other 

State Agency Data

In addition to linking mental health client 

data with Medicaid, many SMHAs reported 

efforts undertaken to integrate or match 

mental health client-level data with other 

state government agencies client databases 

(see Table 42). The most frequently linked 

data are for substance abuse services (often 

in states where the SMHA is responsible for 

both mental health and substance abuse 

services). While many states link their clientlevel data with many other state government 

agencies (such as criminal justice, health, 

employment, and child welfare), this 

procedure is not routine and instead usually 

happens only for designated special projects. 

So far, only Medicaid and substance abuse 

(alcohol/drug abuse) client files are regularly 

integrated or matched with mental health 

records in more than 10 states.

9.3 Participation in Special Projects 

That Strengthen Collaborative 

Relationships With Other State 

Agencies

In 2004, the NRI, under contract with 

CMHS, carried out an initiative of 

identifying mental health services and 

essential supports delivered by many of the 

major state government agencies other than 

the SMHA. These major state government 

agencies are corrections, Medicaid, housing, 

vocational rehabilitation, substance abuse, 

education, juvenile justice, early intervention, 

and child welfare.
Funding and Characteristics of State Mental Health Agencies, 2007 113

This is the first initiative funded by 

CMHS for a group of states to engage other 

state agencies in identifying and gathering 

mental health expenditures, count of clients, 

and revenue sources. The project was 

implemented in two phases in which a total 

of 20 states volunteered to participate. 

Although not all states were able to generate 

data for this project (for varying reasons), it 

allowed the states to start a dialogue with 

these agencies. Overall, the state experiences 

from the project sent a strong message 

supporting the importance of continuing the 

effort of understanding the state mental 

health service delivery system.

The underlying lesson that can be derived 

from all these interagency activities is that 

information from other state agencies 

providing significant levels of mental health 

services will, in the future, become crucial in 

accurately understanding the overall state 

government expenditures on mental health. 

For example, the interagency database 

linking will help inform the mental health 

NOMS, such as the employment and 

criminal justice NOMS. Therefore, as more 

States build state data warehouses, routinely 

link client-level data across systems, and 

participate in various interagency projects, 

the SMHA and other state agencies can 

effectively serve persons with mental illness 

through a well-coordinated system of care.

Table 42: Other State Agencies SMHAs Link Data With

State

Update Frequency Purpose Agency Responsible 

Regularly Special 

Projects

Analysis 

of Mental 

Health 

Services

Admin 

Purposes

Policy 

Analysis SMHA OSA Other

Alcohol and drug abuse 19 9 22 22 20 21 8 13

Criminal justice 5 16 14 13 10 13 5 2

Health 5 14 12 10 6 11 2 2

Employment/vocational rehabilitation 4 11 12 8 7 12 3 1

Child welfare 5 12 12 12 11 12 3 6

Juvenile justice 0 9 7 6 3 9 2 0

Education 1 4 4 4 3 3 1 0

Glossary 

ACT Assertive Community Treatment

ALR Assisted living residence

AMHA American Mental Health Alliance

ASAM American Society of Addiction Medicine

ASI Addiction Severity Index

ASL American Sign Language

ASO Administrative service organization

CAPES Crisis and Psychiatric Emergency Services

CBT Cognitive behavioral therapy

CMHC Community mental health center

CMS Centers for Medicare and Medicaid Systems

CNS Comprehensive neuroscience

CRA Case work, referral, and advocacy

CSR Community staffing resources

DACTS Dartmouth Assertive Community Treatment Scale 

DBHRT Disaster Behavioral Health Response Team

DCS Department of Child Services (IN)

DMHAS Department of Mental Health and Addiction Services (CT)

DSAMH Division of Substance Abuse and Mental Health (DE)

DSM Diagnostic and Statistical Manual of Mental Disorders

EBP Evidence-based practice

EHR Electronic health record

EPSTD Early Periodic Screening Diagnosis Testing

ER Emergency room

FTE Full-time employee

GBMI Guilty but Mentally Ill

G-CAL Georgia Crisis and Access Line

HMO Health management organization

ICF-MI Intermediate-care facility, mentally ill

IOM Institute of Medicine

IPS Individual Placement Support

LMHA Local mental health agency

MAR Medication administration recording

MCO Managed care organization

MICA Mental illness and chemical abuse addition

Funding and Characteristics of State Mental Health Agencies, 2007 115
116 Funding and Characteristics of State Mental Health Agencies, 2007

MITA Medicaid Information Technology Architecture

MR/DD Mental retardation/developmental disability

MST Multisystemic therapy

NASMHPD National Association of State Mental Health Program Directors

NGRI Not Guilty by Reason of Insanity

NOM National Outcome Measure

NTAC National Technical Assistance Center

OBS Organic brain syndrome

OMH Office of Mental Health (LA)

PHR Personal health record

PNFC President’s New Freedom Commission

PORT Patient Outcome Research Team

QA Quality assurance

RDM Resiliency and disease management

RHIO Regional Health Information Organization

SAGA State Administered General Assistance

SED Serious emotional disorder

SMHA State mental health agency

SMI Serious mental illness

SNF Skilled nursing facility

SPMI Severely and persistently mentally ill

SPS NRI’s SMHA Profiling System

TBI Traumatic brain injury

TMAP Texas Medication Algorithm Project 

VNA Visiting nurse agency

WRAP Wellness and Recovery Action Plans
Funding and Characteristics of State Mental Health Agencies, 2007 117

References 

Atay, J., Crider, R., & Foley, D. (2007). 

Additions and resident patients at end of 

year, state and county hospitals, by age 

and diagnosis, by state, United States 

2005. Rockville, MD: Center for Mental 

Health Services, Substance Abuse and 

Mental Health Services Administration.

 CMHS (Center for Mental Health 

Services). (2008). Uniform Reporting 

System (URS) 2007 data. Accessed at 

http://mentalhealth.samhsa.gov/cmhs/

MentalHealthStatistics/UniformReport.

asp.

CMHS (Center for Mental Health Services). 

(2005). Transforming mental health care 

in America, the Federal action agenda: 

First steps. Rockville, MD: Substance 

Abuse and Mental Health Services 

Administration. Accessed at http://www.

samhsa.gov/Federalactionagenda/NFC_

TOC.aspx.

IOM (Institute of Medicine). (2006). 

Committee on crossing the quality 

chasm: Adaptation of mental health 

and addictive disorders—Improving the 

quality of health care for mental and 

substance-use conditions. Washington, 

DC: National Academies Press. Accessed 

at http://books.nap.edu/openbook.

php?record_id=11470&page=29.

Lutterman, T., Ganju, V., Schacht, L., Shaw, 

R., Monihan, K., & Huddle, M. (2003). 

Sixteen state study on mental health 

performance measures. DHHS Pub. No. 

(SMA) 03-3835. Rockville, MD: Center 

for Mental Health Services, Substance 

Abuse and Mental Health Services 

Administration.

Lutterman, T., & Gonzalez, O. (2006). The 

CHMS Uniform Reporting System in 

Center for Mental Health Services. In 

R.W. Manderscheid & J.T. Berry (Eds.), 

Mental health, United States. DHHS 

Pub. No. (SMA) 06-4195. Rockville, 

MD: Substance Abuse and Mental 

Health Services Administration.

NASMHPD (National Association of State 

Mental Health Program Directors). 

(2008). Position statement on a 

framework for comprehensive state 

mental health systems (related to the 

President’s New Freedom Commission 

on Mental Health). Accessed at http://

www.nasmhpd.org/general_files/

position_statement/Comprehensive%20

SMH%20Sytems.pdf.

NRI (National Association of State Mental 

Health Program Directors Research 

Institute, Inc.) (2008). 2007 State mental 

health agency profiling system results. 

Accessed at http://www.nri-inc.org/

projects/Profiles/data_search.cfm.

NRI (National Association of State Mental 

Health Program Directors Research 

Institute, Inc.) (2007). The FY 2005 

state mental health revenue and 
118 Funding and Characteristics of State Mental Health Agencies, 2007

expenditure study results. Accessed 

at www.nri-inc.org/projects/profiles/

revenuesexpenditures.cfm. 

Phelan, B., Lutterman, T., Berhane, A., 

Frank, R., Rivard, J., & Shaw, R. 

(in press). Mental health services 

and supports provided across state 

government agencies. Rockville, MD: 

Center for Mental Health Services, 

Substance Abuse and Mental Health 

Services Administration.

SAMHSA (Substance Abuse and Mental 

Health Services Administration) (2004, 

December 16–17). National consensus 

statement on mental health recovery. 

http://mentalhealth.samhsa.gov/

publications/allpubs/sma05-4129/.

TDMHDD (Tennessee Department of Mental 

Health & Developmental Disabilities) 

(2007, March/April). Update. Vol. 

12, No. 2. Accessed at http://state.

tn.us/mental/publications/update/e_

UpdateMarApr07.pdf.

US Census Bureau. (n.d.) 2005 Survey of 

state government finances, January 

2007. Governments Division. Accessed 

at: http://www.census.gov/govs/www/

state05.html.

US DHHS (US Department of Health 

and Human Services). (2008). 

Transforming mental health care in 

America: The Federal action agenda, 

first steps. Substance Abuse and 

Mental Health Services Administration. 

Accessed at http://www.samhsa.gov/

Federalactionagenda/NFC_TOC.aspx.

US DHHS (US Department of Health and 

Human Services). (2003). New Freedom 

Commission on mental health, achieving 

the promise: Transforming mental health 

care in America. Final Report. DHHS 

Pub. No. (SMA) 03-3832. Rockville, 

MD.

US DHHS (US Department of Health 

and Human Services). (1999). Mental 

health: A report of the surgeon general. 

Rockville, MD: U.S. Department of 

Health and Human Services, Substance 

Abuse and Mental Health Services 

Administration, Center for Mental 

Health Services, National Institute of 

Health, National Institute of Mental 

Health.

US Supreme Court of the United States. 

Kansas v. Hendricks, 521 US 346 (1997, 

June 23). Kansas, petitioner 95-1649 v. 

Leroy Hendricks, petitioner 95-9075. On 

writs of certiorari of the Supreme Court 

of Kansas. Accessed at http://supct.law.

cornell.edu/supct/html/95-1649.ZO.html.
Appendix to 

Funding and Characteristics of 

State Mental Health Agencies, 2007 

 

HHS Pub. No. (SMA) 09-4424 

Funding and Characteristics of the State Mental Health Agencies 0 
Tables of Content

Alabama 2007 ................................................................................................................................. 1 

Alaska 2007 .................................................................................................................................... 5 

Arizona 2007................................................................................................................................. 10 

Arkansas 2007............................................................................................................................... 14 

California 2007 ............................................................................................................................. 18 

Colorado 2007............................................................................................................................... 23 

Connecticut 2007 .......................................................................................................................... 27 

Connecticut Children’s Services 2007.......................................................................................... 32 

Delaware 2007 .............................................................................................................................. 36 

District Of Columbia 2007............................................................................................................ 41 

Florida 2007.................................................................................................................................. 45 

Georgia 2007................................................................................................................................. 49 

Hawaii 2007.................................................................................................................................. 53 

Idaho 2007 .................................................................................................................................... 58 

Illinois 2007 .................................................................................................................................. 61 

Indiana 2007.................................................................................................................................. 65 

Iowa 2007...................................................................................................................................... 70 

Kansas 2007.................................................................................................................................. 74 

Kentucky 2007.............................................................................................................................. 78 

Louisiana 2007.............................................................................................................................. 82 

Maine 2007 ................................................................................................................................... 87 

Maryland 2007.............................................................................................................................. 92 

Massachusetts 2007 ...................................................................................................................... 96 

Michigan 2007 ............................................................................................................................ 100 

Minnesota 2007........................................................................................................................... 104 

Mississippi 2007 ......................................................................................................................... 109 

Missouri 2007 ............................................................................................................................. 110 

Montana 2007 ............................................................................................................................. 114 

Nebraska 2007 ............................................................................................................................ 118 

Nevada 2007 ............................................................................................................................... 120 

New Hampshire 2007 ................................................................................................................. 124 

New Jersey 2007......................................................................................................................... 128 

New Mexico 2007....................................................................................................................... 133 

New York 2007........................................................................................................................... 138 

Funding and Characteristics of the State Mental Health Agencies i 
Funding and Characteristics of the State Mental Health Agencies ii 

North Carolina 2007 ................................................................................................................... 142 

North Dakota 2007...................................................................................................................... 147 

Ohio 2007.................................................................................................................................... 151 

Oklahoma 2007........................................................................................................................... 155 

Oregon 2007................................................................................................................................ 160 

Pennsylvania 2007 ...................................................................................................................... 165 

Rhode Island 2007 ...................................................................................................................... 170 

South Carolina 2007 ................................................................................................................... 174 

South Dakota 2007...................................................................................................................... 178 

Tennessee 2007........................................................................................................................... 182 

Texas 2007.................................................................................................................................. 186 

Utah 2007.................................................................................................................................... 191 

Vermont 2007 ............................................................................................................................. 196 

Virginia 2007 .............................................................................................................................. 201 

Washington 2007 ........................................................................................................................ 205 

West Virginia 2007..................................................................................................................... 209 

Wisconsin 2007........................................................................................................................... 213 

Wyoming 2007............................................................................................................................ 217 
ALABAMA 2007 

Department of Mental Health 

and Mental Retardation 

100 N. Union Street 

Montgomery, AL 36130 

http://www.mh.alabama.gov

The Alabama Department of Mental Health/Mental Retardation 

(DMH/MR) is responsible for mental illness, mental 

retardation, and substance abuse services. The Department is 

responsible for operating state psychiatric facilities, 

establishing standards for community services, and is 

empowered to contract for services. 

Statistics: 

State Population (2006): 4,599,030 

Number of Persons Served (2007): 102,025 

Utilization Rate for Adults: 22 per 1,000 

Utilization Rate for Children: 22 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $273.70 million 

Revenue From Medicaid $92 million 

Expenditures for Community Mental Health Services (51% of Total Mental 

Health Agency Revenues) $140.6 million 

Per Capita State Mental Health Expenditures $60.31 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic 

Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain 

Syndrome Services 

Responsibility for services is shared with 

another agency 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in 

Prison/Jail 

Responsibility for services is shared with 

another agency 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Funding and Characteristics of the State Mental Health Agencies 1 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in a different state department 

Substance Abuse Agency Part of SMHA 

State Housing Department Located in a different state department 

State Health Department Located in a different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 6 0 6 

Community Mental Health Providers 0 26 26 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 1 0 1 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs

Assertive Community Treatment (ACT) Parts of the state 13 

Consumer-Operated Services Parts of the state 5 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation Number of Programs 

In-Home Intervention Available statewide 25 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the mental health workforce. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 31 percent. 

Mental health parity laws: 

The state does not mandate mental health insurance benefits. 

Funding and Characteristics of the State Mental Health Agencies 2 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Health Yes Yes 

Education No Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Multiple needs child legislation. 

Telemedicine: 

The SMHA promotes the use of telemedicine; piloted use of telemedicine for psychiatry and 

pediatric interface. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals. The state does not use a 

single EHR system for all community mental health providers. Local providers use a variety of 

EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are six SMHA-operated state psychiatric hospitals and one nursing home. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 13 and for adults was 1,137 receiving state 

psychiatric inpatient care. 

Funding and Characteristics of the State Mental Health Agencies 3 
State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in general hospital specialty unit psychiatric, state psychiatric hospital, and private 

psychiatric hospital beds in the last 5 years. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard to assure the provision of services to meet 

the mental health needs of veterans and National Guard members. There is a State of Alabama 

Returning Veterans Committee with representatives from the State Office of Veteran Affairs. 

Funding and Characteristics of the State Mental Health Agencies 4 
ALASKA 2007 

Division of Behavioral 

Health Services 

Department of Human 

Services 

DBH, 3601 C Street 

Suite 878 

Anchorage, AK 99645

The Department of Health and Social Services (DHSS), Division 

of Behavioral Health (DBH) is responsible for the State’s public 

mental health system and substance disorder programs. Alaska’s 

public mental health system consists of three components: 

community mental health programs, Alaska Psychiatric Institute, 

and Designated Evaluation and Treatment services. DBH 

administers the statewide system of community mental health 

programs for delivery of residential and community-based 

treatment and recovery services; manages Alaska Psychiatric 

Institute (API), the state’s only public psychiatric hospital; 

administers grants to the state’s network of local community 

mental health programs; and coordinates with other government, 

tribal, and private providers of mental health services to ensure 

the provision of comprehensive mental health services to Alaska 

residents. DBH works closely with the Alaska Mental Health 

Board (AMHB), the state’s mental health planning council, on 

system planning and evaluation. 

Statistics: 

State Population (2006): 670,053 

Number of Persons Served (2007): 24,675 

Utilization Rate for Adults: 25 per 1,000 

Utilization Rate for Children: 69.0 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures Dollars 

Total Mental Health Agency-Controlled Revenues $173.6 million 

Revenue From Medicaid $134.6 million 

Expenditure for Community Mental Health Services (86% of Total SMHA 

Revenues) $149.4 million 

Per Capita State Mental Health Spending $269.6 

Funding and Characteristics of State Mental Health Agencies, 2007– Alaska 5 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic 

Brain Injuries) Part of the SMHA 

Alzheimer’s Disease and Organic Brain 

Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in 

Prison/Jail Responsibility shared with another agency 

Sex Offender Services Part of the SMHA 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department as the SMHA 

Substance Abuse Agency Part of the SMHA 

State Housing Department Same umbrella department as the SMHA 

State Health Department Same umbrella department as the SMHA 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 1 0 1 

Community Mental Health Providers 0 68 68 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

 

Funding and Characteristics of State Mental Health Agencies, 2007– Alaska 6 
Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs

Assertive Community Treatment (Act)    1 

Supported Employment Pilot program; 

Parts of the state 4 

Medication Algorithms (Schizophrenia) Statewide 

Medication Algorithms (Bipolar Disorders) Statewide 

Family Psychoeducation Parts of the state 

Integrated MH/Substance Abuse Services Statewide 

Self-Management Pilot program 2 

Supported Housing Statewide 4 

Consumer-Operated Services Pilot program 3 

Multisystemic Therapy (Conduct Disorder) Pilot program 

Therapeutic Foster Care Statewide 1 

Functional Family Therapy Pilot program 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation Number of Programs 

Treatment, Trauma Treatment Available in parts of state 1 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce, Alaska Mental 

Health Trust Authority workforce initiative. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 48 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has lead responsibility 

Writing waiver SMHA has lead responsibility 

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

SMHA serves as managed care agent SMHA has lead responsibility 

Mental health parity laws: 

The state does not mandate mental health insurance benefits. 

Funding and Characteristics of State Mental Health Agencies, 2007– Alaska 7 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Corrections No Yes 

Health No Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine; rural program and state hospital collaborate. 

Electronic Health Records (EHR): 

The SMHA is in the process of installing an EHR in the single state psychiatric hospital. The 

SMHA has some EHR components implemented in state hospitals and community mental health 

programs. The state uses a single EHR system for all community mental health providers. Seven 

local providers use a variety of EHR systems, which interface with the state EHR database. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one SMHA-operated state psychiatric hospital. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 13 and for adults was 51 receiving state 

psychiatric inpatient care. 

Funding and Characteristics of State Mental Health Agencies, 2007– Alaska 8 
State psychiatric hospital patient legal status: 

Note: Percentage may not total 100 because of rounding. 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in state psychiatric hospital beds in the last 5 years. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members. Alerts to community mental health agencies on determination of 

benefits for services related to Traumatic Brain Injury (TBI) training to the Veterans 

Administration used Department of Defense standards for screening/treatment of TBI. 

Funding and Characteristics of State Mental Health Agencies, 2007– Alaska 9 
ARIZONA 2007 

Division of Behavioral 

Health Services 

Department of Health 

Services 

150 N 18th Ave, Suite 240 

Phoenix, AZ 85007 

http://www.azdhs.gov/bhhs

The organizational structure for Arizona’s system of care is 

divided into six geographical regions (GSAs), designed to 

promote a service system that is responsible to and reflective of 

the unique needs of a specific area of the state and its 

population. The direct local administration of the system is 

accomplished by nonprofit and for-profit organizations known 

as Regional Behavioral Health Authorities (RBHAs). In 

addition, four Arizona Indian Tribes contract with the state for 

behavioral health services. These are the Pascua Yaqui Tribe 

and Gila River Indian Community, who operate as TRBHAs, the 

Colorado River Indian Tribe, contracted to provide Subvention 

(state only) funded services, and the Navajo Nation, previously a 

TRBHA, but now operating as a case management provider. 

Statistics: 

State Population (2006): 6,166,318 

Number of Persons Served (2007): 143,964 

Utilization Rate for Adults: 22 per 1,000 

Utilization Rate for Children: 26.0 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $867.3 million 

Revenue From Medicaid $662.4 million 

Expenditures for Community Mental Health Services (91.2% of Total 

Mental Health Agency Revenues) $791.4 million 

Per Capita State Mental Health Expenditures $146.22 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Shared with another agency 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status No responsibility 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Arizona 10 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Different state department 

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Part of SMHA 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 1 0 1 

Community Mental Health Providers 0 463 463 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Evidence-based services: 

Evidence-Based Practice Implementation 

Assertive Community Treatment (Act) Parts of the state 

Supported Employment Statewide 

Medication Algorithms (Schizophrenia) Statewide 

Integrated MH/Substance Abuse Services Statewide 

Self-Management Parts of the state 

Supported Housing Statewide 

Consumer-Operated Services Statewide 

Multisystemic Therapy (Conduct Disorder) Pilot program 

Therapeutic Foster Care Statewide 

Functional Family Therapy Parts of the state 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation Number of Programs 

Teen Screen Available in parts of state 3 

Employment/Psychiatric Rehabilitation Available statewide 

Note: Blank space indicates the state did not report data for this category. 

Funding and Characteristics of State Mental Health Agencies, 2007– Arizona 11 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the mental health workforce. The SMHA 

sponsors/conducts multiple training and TA initiatives: the Behavioral Health/Higher Education 

Partnership to improve quality, recruitment, and retention; Behavioral Health Loan Repayment 

Program, modeled on National Health Service Corps, established in statute in 2005. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid Research and Demonstration 

(1115) waiver. 

State’s share of the Medicaid match is 29 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency 

Writing waiver SMHA has no responsibility 

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

SMHA serves as managed care agent SMHA has lead responsibility 

Mental health parity laws: 

The state mandates mental health insurance benefits. These benefits include any mental health 

service, but not substance abuse services. The following diagnoses are included: limited parity 

covering number of visits and lifetime maximums but not copays, coinsurance, deductibles. The 

mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes No 

Corrections No Yes 

Education No Yes 

Juvenile Justice No Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. 

Funding and Characteristics of State Mental Health Agencies, 2007– Arizona    12
Funding and Characteristics of State Mental Health Agencies, 2007– Arizona 13 

Telemedicine: 

The SMHA promotes the use of telemedicine. Telemedicine network is extensive and has been 

in place for many years. Northern Arizona network was selected as one of the top five nationally. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals and community mental 

health programs. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one SMHA-operated state psychiatric hospital. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity.
ARKANSAS 2007 

Division of Behavioral Health 

Services 

Department of Human Services 

305 S. Palm Street 

Little Rock, AR 72205 

http://www.arkansas.gov/dhs/dmhs

The Division of Behavioral Health Services (DBHS) is 

Arkansas’ Single State Agency for both mental health and 

substance abuse treatment/prevention services. DBHS 

discharges its responsibility for the provision of public 

mental health services by operating the Arkansas State 

Hospital (ASH) and the Arkansas Health Center skilled 

nursing facility, by contracting with 15 local, private, 

nonprofit Community Mental Health Centers (CMHCs), 

and by certifying 3 private nonprofit specialty community 

mental health clinics. 

Statistics: 

State Population (2006): 2,810,872 

Number of Persons Served (2007): 69,228 

Utilization Rate for Adults: 23 per 1,000 

Utilization Rate for Children: 30.0 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $98.6 million 

Revenue From Medicaid $25.8 million 

Expenditures for Community Mental Health Services (64% of Total 

Mental Health Agency Revenues) $63 million 

Per Capita State Mental Health Expenditures $35.6 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services Part of the SMHA 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies – Arkansas 14 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department as the SMHA 

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 1 0 1 

Community Mental Health Providers 0 15 15 

Nursing Homes and Other ICF-MI and SNF Providers 1 0 1 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state 4 

Supported Employment Parts of the state 6 

Family Psychoeducation Parts of the state 4 

Integrated Mental Health/Substance Abuse 

Services Parts of the state 4 

Self-Management Parts of the state 5 

Supported Housing Parts of the state 6 

Therapeutic Foster Care Parts of the state 8 

Functional Family Therapy Parts of the state 2 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation Number of 

Programs 

Mental Health Consultation Child Care 

Program Available in parts of state 

Peer-Led Support Groups at ASH Available in parts of state 1 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. CoSig grant is 

funding training of mental health and substance abuse provider staff. 

Funding and Characteristics of State Mental Health Agencies – Arkansas 15 
Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. 

State’s share of the Medicaid match is 26 percent. 

Mental health parity laws: 

The state mandates mental health insurance benefits. 

The mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Health Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. There were no children who had their parents’ custody 

relinquished in 2007 in order to receive mental health services. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals. The SMHA has some EHR 

components implemented in community mental health programs. The state does not use a single 

EHR system for all community mental health providers. Local providers use a variety of EHR 

systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one SMHA-operated state psychiatric hospital. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 30 and for adults was 167 receiving state 

psychiatric inpatient care. 

Funding and Characteristics of State Mental Health Agencies – Arkansas 16 
Funding and Characteristics of State Mental Health Agencies – Arkansas 17 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in general hospital specialty unit psychiatric beds in the last 5 years.
CALIFORNIA 2007 

California Department of 

Mental Health 

1600 9th Street, Room 151 

Sacramento, CA 95814 

(800) 896-4042 

http://www.dmh.ca.gov

The California Department of Mental Health is an independent 

agency responsible for providing mental health services. The 

primary public providers of mental health services are 

California’s 58 county mental health agencies and 2 city 

agencies (Berkeley and Tri-City), the majority run by county 

governments. 

Statistics: 

State Population (2006): 36,457,549 

Number of Persons Served (2006): 658,314 

Utilization Rate for Adults: 17 per 1,000 

Utilization Rate for Children: 22.0 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $4.3 billion 

Revenue From Medicaid $1.8 billion 

Expenditure for Community Mental Health Services (81% of Total 

SMHA Revenues) $3.5 billion 

Per Capita State Mental Health Spending $118.65 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Part of the SMHA 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Shared with another agency 

Funding and Characteristics of State Mental Health Agencies, 2007– California 18 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Different state department

Substance Abuse Agency Different state department 

Housing Agency Different state department 

Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

Unduplicated 

State Psychiatric Hospitals 5 0 5

Community Mental Health Providers 0 2,484 2,484

Private Psychiatric Hospitals NA 41 41

General Hospitals With Separate Psychiatric 

Units 0 54 54

Nursing Homes and Other ICF-MI and SNF 

Providers 0 83 83

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Evidence-based services: 

Evidence-Based Practice Implementation 

Assertive Community Treatment (ACT) Parts of the state 

Supported Employment Parts of the state 

Family Psychoeducation Parts of the state 

Integrated Mental Health/Substance Abuse Services Parts of the state 

Self-Management Parts of the state 

Supported Housing Parts of the state 

Consumer-Operated Services Parts of the state 

Multisystemic Therapy (Conduct Disorder) Parts of the state 

Therapeutic Foster Care Parts of the state 

Funding and Characteristics of State Mental Health Agencies, 2007– California 19 
Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation 

Aggression Replacement Parts of the state 

Child/Adolescents Wraparound Parts of the state 

Adult Self-Help Centers Parts of the state 

Adult Wellness and Recovery Centers Parts of the state 

Adult Tribal Integration Parts of the state 

Older Adult Integrated MH Primary Care Parts of the state 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the mental health workforce. DMH is 

proposing a comprehensive approach that includes: partially funding psychiatric residency 

programs; adding a mental health specialty to existing physician assistant programs; establishing 

a statewide loan assumption program; establishing a statewide client and family member 

technical assistance center; establishing regional partnership staffing support; establishing 

learning at a distance; developing leaders for the public health system; developing client entrylevel employment preparation programs; establishing mental health career pathway programs; 

and establishing stipend programs for graduate-level clinical psychologists, social workers, 

marriage and family therapists, and psychiatric mental health nurse practitioners. 

Managed behavioral healthcare: 

Mental health services are being delivered via managed care. These behavioral health services 

are administered through a Medicaid 1915(b) waiver. The state’s share of the Medicaid match is 

50 percent.

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency

Writing waiver SMHA has lead responsibility 

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Funding and Characteristics of State Mental Health Agencies, 2007– California 20 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid No Yes 

Corrections Yes No 

Health No Yes 

Housing No Yes 

Education No Yes 

Juvenile Justice No Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: California allows for 12 months of voluntary 

placement through the county’s child welfare system that meets the needs of this type of 

parent/family crisis. Assembly Bill (AB) 3632 ensures that special education children who 

require mental health services may receive these services from county mental health programs. 

Telemedicine:

The SMHA promotes the use of telemedicine. Some California county mental health programs 

use telemedicine through California Department of Mental Health funding. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals. The SMHA encourages and 

supports the development of county and provider EHR systems in community mental health 

programs. California counties and providers have implemented some EHR components in 

community mental health programs. The SMHA has some EHR components implemented in 

community mental health programs. The state does not use a single EHR system for all 

community mental health providers. Local providers use a variety of EHR systems. 

State psychiatric hospital: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are five SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes 

Forensic Yes Yes Yes 

Note: Blank space indicates the state did not report data for this category. 

Average daily census in FY 2006 for youth was 120 and for adults was 4,172 receiving state 

psychiatric inpatient care. 

Funding and Characteristics of State Mental Health Agencies, 2007– California 21 
State psychiatric hospital patient legal status: 

The commitment status of patients in state hospital on the last day of the year shows that 0.8 

percent were voluntarily admitted, 17.0 percent were involuntarily civilly committed, while 82.2 

percent were involuntarily criminally committed. 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in general hospital specialty unit psychiatric, state psychiatric hospital, and private 

psychiatric hospital beds in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Departments of Veterans 

Affairs and Defense to assure the provision of services to meet the mental health needs of 

veterans and National Guard members. 

Funding and Characteristics of State Mental Health Agencies, 2007– California 22 
COLORADO 2007 

3824 W. Princeton Circle 

Denver, CO 80236 

Colorado’s public mental health system comprises community-based 

mental health programs overseen by the Division of Mental Health, 

the two state mental health Institutes (both of which are 

organizationally part of the Office of Behavioral Health and 

Housing within the Department of Human Services), and the 

Medicaid-funded community-based mental health programs 

overseen by the Department of Health Care Policy and Financing 

(HCPF). 

Statistics: 

Statistics Population (2006): 4,753,377 

Number of Persons Served (2007): 75,198 

Utilization Rate for Adults: 13 per 1,000 

Utilization Rate for Children: 24.0 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $343.8 million 

Revenue From Medicaid $176.3 million 

Expenditures for Community Mental Health Services (73% of Total 

Mental Health Agency Revenues) $252.4 million 

Per Capita State Mental Health Expenditures $74.28 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency 

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Shared with another agency 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services No responsibility 

State Mental Hospitals Shared with another agency 

Community Mental Health Program Shared with another agency 

Funding and Characteristics of State Mental Health Agencies, 2007– Colorado 23 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in a different state department 

Substance Abuse Agency Part of SMHA 

State Housing Department Located in the same umbrella department as 

the SMHA 

State Health Department Located in a different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 2 0 2 

Community Mental Health Providers 0 23 23 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state 8 

Supported Employment Parts of the state 8 

Family Psychoeducation Parts of the state 4 

Integrated MH/Substance Abuse Services Parts of the state 9 

Self-Management Parts of the state 6 

Supported Housing Parts of the state 12 

Consumer-Operated Services Parts of the state 

Multisystemic Therapy (Conduct Disorder) Parts of the state 4 

Therapeutic Foster Care Parts of the state 0 

Functional Family Therapy Parts of the state 8 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation Number of Programs 

Wraparound Services Available in parts of state 4 

Dialectical Behavioral Therapy Available in parts of state 5 

Specific Substance Abuse/Mental

Illness Treatment Available in parts of state 5 

Workforce development initiatives: 

The SMHA is developing initiatives to improve the quality of the mental health workforce with 

an emphasis on cultural competency and rural and frontier issues. 

Funding and Characteristics of State Mental Health Agencies, 2007– Colorado 24 
Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has no responsibility 

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA has no responsibility 

Evaluating SMHA has no responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Mental health parity laws: 

The state mandates mental health insurance benefits. 

Only benefits for specific mental health diagnoses are included. The following diagnoses are 

included: biologically based mental illness (e.g., schizophrenia, schizoaffective disorder, bipolar 

affective disorder, major depressive disorder, specific OCOD diagnoses, panic disorder). 

The mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid No Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice No Yes 

Child Welfare No Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Child Mental Health Tx Act (1116). 

Telemedicine: 

The SMHA promotes the use of telemedicine. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals. The SMHA has some EHR 

components implemented in community mental health programs. The state does not use a single 

EHR system for all community mental health providers. Local providers use a variety of EHR 

systems. 

Funding and Characteristics of State Mental Health Agencies, 2007– Colorado                                          25
State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is not within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are two SMHA-operated state psychiatric hospitals. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 33 and for adults was 486 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in general hospital specialty unit psychiatric beds in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members. 

Colorado has established youth and family mental health services for veterans in the Colorado 

Springs area. Connections are made to Vet centers, the state Veterans Administration (VA) 

hospital, and other outpatient VA-funded providers.

Funding and Characteristics of State Mental Health Agencies, 2007– Colorado                                          26
CONNECTICUT 2007 

Department of Mental Health 

and Addiction Services 

410 Capitol Avenue 

Hartford, CT 06134 

http://www.ct.networkofcare.org 

The Department of Mental Health and Addiction Services 

(DMHAS) and the Department of Children and Families 

(DCF) are responsible for Connecticut’s public mental health 

system. Although mental health services for children and 

adults are administered separately in Connecticut, the two 

departments work closely to ensure the provision of quality 

mental health services, and continue to plan and implement 

effective transitional services for youth moving from DCF to 

the adult system of care. DMHAS, through a network of l5 

community-based Local Mental Health Authorities, provides 

a full range of treatment and recovery-support services to 

adults (age 18 and older). DMHAS is also responsible for 

adult forensic services in the state. DCF is an integrated child 

protective service agency and is legislatively mandated to 

provide mental health, prevention, juvenile justice, substance 

abuse, and child welfare services in Connecticut. 

Statistics: 

State Population (2006): 3,504,809 

Number of Persons Served (2007): 79,221 

Utilization Rate for Adults: 19 per 1,000 

Utilization Rate for Children: 33.0 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $549.2 million 

Revenue From Medicaid $23.4 million 

Expenditures for Community Mental Health Services (60% of Total 

Mental Health Agency Revenues) $328 million 

Per Capita State Mental Health Expenditures $157.21 

Funding and Characteristics of State Mental Health Agencies, 2007– Connecticut 27 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services No responsibility 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Shared with another agency 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in a different state department 

Substance Abuse Agency Part of SMHA 

State Housing Department Located in a different state department 

State Health Department Located in a different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 4 0 4 

Community Mental Health Providers 9 115 124 

Private Psychiatric Hospitals NA 1 1 

General Hospitals With Separate Psychiatric Units 0 11 11 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Funding and Characteristics of State Mental Health Agencies, 2007– Connecticut 28 
Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Statewide 28 

Supported Employment Parts of the state 8 

Medication Algorithms (Schizophrenia) Parts of the state 

Family Psychoeducation Parts of the state 

Integrated MH/Substance Abuse Services Parts of the state 22 

Self-Management Parts of the state 

Supported Housing Statewide 98 

Consumer-Operated Services Statewide 4 

Multisystemic Therapy (Conduct Disorder) Parts of the state 

Therapeutic Foster Care Statewide 

Functional Family Therapy Statewide 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation 

Risking Connections Available in parts of state 

Trauma Adaptive Recovery Group Ed and Training Available in parts of state 

Cognitive Behavioral Intervention and Treatment Available in parts of state 

Wellness and Recovery Action Plans (WRAP) Available in parts of state 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the mental health workforce. Mental Health 

Transformation State Incentive Grant (MHT SIG) funding being used to address multiple 

initiatives focusing on workforce development. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. State’s share of 

the Medicaid match is 50 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has no responsibility

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA has no responsibility 

Evaluating SMHA has no responsibility 

SMHA serves as managed care agent SMHA has lead responsibility 

Funding and Characteristics of State Mental Health Agencies, 2007– Connecticut 29 
Mental health parity laws: 

The state mandates mental health insurance benefits. 

These benefits include any mental health and substance abuse service. 

The mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Housing Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: variety of services including voluntary services 

available to assist families in resolving problems and remaining intact. 

Telemedicine: 

The SMHA promotes the use of telemedicine. Telemedicine project was launched in 2007 and is 

currently awaiting additional resources for its continuation. Telemedicine pilot program is 

designed to reach out to monolingual clients as well as providing access in geographically 

remote areas. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals and community mental 

health programs. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are four SMHA-operated state psychiatric hospitals. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes 

Forensic Yes Yes Yes 

Funding and Characteristics of State Mental Health Agencies, 2007– Connecticut 30 
The average daily census in FY 2006 for youth was 31 and adults was 572 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Note: Percentage may not total 100 because of rounding. 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members. National Guard: DMHAS provides behavioral health counseling 

services to guard/reserve personnel and their families through a 200-plus statewide network of 

licensed clinicians. VA: As a member of Connecticut’s State Coordination Committee serving 

deployed personnel, DMHAS works in close partnership with VA Healthcare and Vet Center 

system.

Funding and Characteristics of State Mental Health Agencies, 2007– Connecticut 31 
CONNECTICUT Children’s Services 2007 

Department of 

Children and 

Families 

505 Hudson Street 

Hartford, CT 06106 

The Department of Children and Families (DCF) is an integrated child 

protective service agency and is legislatively mandated to provide mental 

health, prevention, juvenile justice, substance abuse, and child welfare 

services in Connecticut. Although mental health services for children and 

adults are administered separately in Connecticut, DCF works closely 

with the Department of Mental Health and Addiction Services (DMHAS) 

to oversee Connecticut’s public mental health system. Primary goals are 

to ensure the provision of quality mental health services, and to continue 

to plan and implement effective transitional services for youth moving 

from DCF to the adult system of care. 

Statistics: 

State Population (2006): 3,504,809 

Child Population (2006): 818,286 

Number of Persons Served (2007): 27,330 

Utilization Rate for Children: 30.0 per 1,000 

Responsibilities of DCF in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services DCF 

Elderly Mental Health Services No responsibility 

Adult Forensic Mental Health Services No responsibility 

Brain Impaired Services (including Traumatic 

Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain 

Syndrome Services No responsibility 

Court Evaluation of Mental Health Status DCF 

Services to Persons With Mental Illness in 

Prison/Jail No responsibility 

Sex Offender Services DCF 

State Mental Hospitals DCF 

Community Mental Health Program Shared with another agency and DCF 

Location of other state agencies in relation to the DCF: 

Agency Location 

State Medicaid Agency Located in a different state department 

Substance Abuse Agency Part of DCF 

State Housing Department Located in a different state department 

State Health Department Located in a different state department 

Funding and Characteristics of State Mental Health Agencies, 2007– Connecticut Children’s Services 32 
The number of mental health providers DCF operates or funds: 

Mental Health Providers DCFOperated 

DCFFunded Total 

State Psychiatric Hospitals 1 1 1 

Community Mental Health Providers 0 133 133 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

DCF funds community‐based service providers across the state. DCF also operates and funds the state

psychiatric hospital and two residential treatment facilities.  

Evidence-based services: 

Evidence-Based Practice Implementation 

Multisystemic Therapy Parts of the state

Functional Family Therapy Statewide 

Multidimensional Family Therapy Statewide 

Trauma-Focused Cognitive Behavior Therapy Parts of the state 

Dialectical Behavior Therapy Statewide 

Cognitive Behavior Therapy Parts of the state 

Intensive In-Home Child and Adolescent Psychiatric Services Statewide 

Family-Based Recovery Parts of the state 

Therapeutic Foster Care Statewide 

Emerging evidence-based and innovative practices: 

Emerging EBPs and Innovative Practices Availability 

Risking Connections Available in parts of state 

Trauma Adaptive Recovery Group Education and Training Available in parts of state 

Sanctuary Model Available in parts of state 

Workforce development initiatives: 

The DCF has initiatives to improve the quality of mental health workforce, generally through 

training of current workforce, resident programs, and liaison with colleges/universities. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid Research and Demonstration 

(115) waiver. 

Funding and Characteristics of State Mental Health Agencies, 2007– Connecticut Children’s Services 33 
DCF’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system Shared with another agency 

Writing waiver Shared with another agency 

Contracting Shared with another agency 

Monitoring Shared with another agency 

Evaluating Shared with another agency 

SMHA serves as managed care agent Shared with another agency 

Mental health parity laws: 

The state mandates mental health insurance benefits. 

These benefits include any mental health and substance abuse service. 

The mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The DCF has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections No Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to child welfare or juvenile justice systems) in order for them to obtain mental health services. 

Description of the policies/laws: A variety of services including voluntary services are available 

to assist families in resolving problems and remaining intact. 

Telemedicine: 

The SMHA promotes the use of telemedicine. Telemedicine project was launched in 2007 and is 

currently awaiting additional resources for its continuation. Telemedicine pilot program is 

designed to reach out to monolingual clients as well as providing access in geographically 

remote areas. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals. Many community-based 

service providers have implemented or are in the process of implementing EHRs. 

Funding and Characteristics of State Mental Health Agencies, 2007– Connecticut Children’s Services 34 
State psychiatric hospitals: 

The responsibility for the operation of the state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one DCF-operated state psychiatric hospital. 

DCF uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2007 for youth was 71.2. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. 

Funding and Characteristics of State Mental Health Agencies, 2007– Connecticut Children’s Services 35 
DELAWARE 2007 

Division of Substance 

Abuse and Mental Health 

Delaware Health and 

Social Services 

1901 N. Dupont HWY 

New Castle, DE 19720

The Delaware Health and Social Services/Division of Substance 

Abuse and Mental Health (DSAMH) has responsibility and 

administrative oversight for the Community Mental Health Services 

Block Grant (CMHSBG). The Division of Substance Abuse and 

Mental Health is responsible for meeting the treatment, 

rehabilitation, and support needs of adults, age 18 years and older, 

with serious mental illness (SMI). The division seeks to provide 

these services to consumers if they are unable to obtain community 

support through other state agencies. A portion of the CMHSBG 

award is allocated to the Department of Services for Children, 

Youth and Their Families/Division of Child Mental Health Services 

(DCMHS). The Division of Child Mental Health Services plans for, 

undertakes, and monitors mental health activities funded under the 

Block Grant for individuals less than 18 years of age. 

Statistics: 

State Population (2006): 853,476 

Number of Persons Served (2007): 9,756 

Utilization Rate for Adults: 9 per 1,000 

Utilization Rate for Children: 12.0 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $74.8 million 

Revenue From Medicaid $14.9 million 

Expenditures for Community Mental Health Services (46% of Total 

Mental Health Agency Revenues) $34.1 million 

Per Capita State Mental Health Expenditures $89.19 

Funding and Characteristics of State Mental Health Agencies, 2007– Delaware 36 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services No responsibility 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Responsibility for services is shared with 

another agency 

Brain Impaired Services (including Traumatic 

Brain Injuries) 

Responsibility for services is shared with 

another agency 

Alzheimer’s Disease and Organic Brain 

Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in 

Prison/Jail No responsibility 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department as the SMHA 

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Same umbrella department as the SMHA 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 1 0 1 

Community Mental Health Providers 4 17 21 

Private Psychiatric Hospitals NA 3 3 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 1 0 1 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly operates local community-based agencies. 

Funding and Characteristics of State Mental Health Agencies, 2007– Delaware 37 
Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Statewide 4 

Supported Employment Statewide 4 

Family Psychoeducation Parts of the state 

Integrated MH/Substance Abuse Services Parts of the state 

Self-Management 4 

Supported Housing Statewide 

Consumer-Operated Services Parts of the state 

Multisystemic Therapy (Conduct Disorder) Pilot program 

Therapeutic Foster Care Parts of the state 50 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. DSAMH’s training 

office provides continuing education for professional examination including the Delaware Board 

of Nursing, Delaware Certification Board, National Association for Alcoholism and Drug Abuse 

Counselors, and National Board of Certified Counselors. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid Research and Demonstration 

(1115) waiver. State’s share of the Medicaid match is 50 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency 

Writing waiver SMHA jointly responsible with Medicaid agency 

Contracting SMHA jointly responsible with Medicaid agency 

Monitoring SMHA jointly responsible with Medicaid agency 

Evaluating SMHA jointly responsible with Medicaid agency 

SMHA serves as managed care agent SMHA jointly responsible with Medicaid agency 

Mental health parity laws: 

The state mandates mental health insurance benefits. 

These benefits include any mental health and substance abuse service. The mandate includes 

parity with physical health service benefits. 

Funding and Characteristics of State Mental Health Agencies, 2007– Delaware 38 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections No Yes 

Health Yes Yes 

Housing No Yes 

Education No No 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: State does not require custody relinquishment in 

order to receive MH/SA services. Works extremely hard to keep the family system together. 

There were no children who had their parents’ custody relinquished in 2007 in order to receive 

mental health services. 

Electronic Health Records (EHR): 

The SMHA is in the process of installing an EHR in state hospitals and community mental health 

programs. Local providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one SMHA-operated state psychiatric hospital. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes 

Adolescents Yes 

Adults Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for adults was 242 receiving state psychiatric inpatient 

care. 

Funding and Characteristics of State Mental Health Agencies, 2007– Delaware 39 
State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the Federal Department of Veterans Affairs to assure the provision 

of services to meet the mental health needs of veterans and National Guard members. Front Door 

Teams have been established at the CMHC system. These teams were established to create an 

“open door” to mental health services. Individuals served on these teams, including veterans, are 

assisted with immediate mental health service supports. Connections are made to Vet centers, the 

state Veterans Administration (VA) hospital, and other outpatient VA-funded providers.

Funding and Characteristics of State Mental Health Agencies, 2007– Delaware 40 
DISTRICT OF COLUMBIA 2007 

Department of Mental 

Health 

64 New York Avenue, NE 

4th Floor 

Washington, DC 20002

The Department of Mental Health (DMH) is a Cabinet-level agency 

whose Director reports to the Office of the Mayor of the District of 

Columbia. The primary mission of DMH is to address the mental 

health services and support needs of District residents. To 

accomplish this mission, DMH is structured with a meaningful 

separation between its authority role (policymaker for the mental 

health system) and its provider components, the D.C. Community 

Services Agency (public provider of core, specialty, and other 

services) and Saint Elizabeth’s Hospital (public provider of a 

variety of inpatient services). 

Statistics: 

State Population (2006): 581,530 

Number of Persons Served (2007): 13,201 

Utilization Rate for Adults: per 1,000 

Utilization Rate for Children: 26.0 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue 233.8 million 

Revenue From Medicaid 32.8 million 

Expenditures for Community Mental Health Services (57% of Total 

Mental Health Agency Revenues) 132.3 million 

Per Capita State Mental Health Expenditures $404.40 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency 

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain 

Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome 

Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Shared with another agency 

Funding and Characteristics of State Mental Health Agencies, 2007– District of Columbia 41 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Different state department

Substance Abuse Agency Different state department 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 1 0 1 

Community Mental Health Providers 1 49 50 

Primary mechanism in delivering mental health services: 

SMHA directly operates local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Statewide   5 

Supported Employment Statewide 6 

Medication Algorithms (Schizophrenia) Pilot program 0 

Integrated MH/Substance Abuse Services Pilot program 

Supported Housing Statewide 1 

Consumer-Operated Services Parts of the state 0 

Multisystemic Therapy (Conduct Disorder) Statewide 1 

Note: Blank space indicates the state did not report data for this category. 

Managed behavioral healthcare: 

Mental health services are being delivered via managed care. 

State’s share of the Medicaid match is 30 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has lead responsibility

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

Mental health parity laws: 

The mandate does not include parity with physical health service benefits. The SMHA does not 

mandate mental health insurance benefits. 

Funding and Characteristics of State Mental Health Agencies, 2007– District of Columbia 42 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes 

Housing Yes Yes 

Note: Blank space indicates the state did not report data for this category. 

Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. There were no children who had their parents’ custody 

relinquished in 2007 in order to receive mental health services. 

Telemedicine: 

The SMHA does not promote the use of telemedicine. 

Electronic Health Records (EHR): 

The SMHA is in the process of installing an EHR in state hospitals. The SMHA has 

implemented all EHR components in community mental health programs. The state uses a single 

EHR system for all community mental health providers. Local providers do not use a variety of 

EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one SMHA-operated state psychiatric hospital. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes 

Funding and Characteristics of State Mental Health Agencies, 2007– District of Columbia 43 
State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

There have been declines in state psychiatric hospital beds in the last 5 years. The state is not 

experiencing a shortage of psychiatric beds. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members; developing a grant for service department for veterans that will focus 

on jail diversion

Funding and Characteristics of State Mental Health Agencies, 2007– District of Columbia 44 
FLORIDA 2007 

Department of Children and Families 

Mental Health 

1317 Winewood Boulevard 

Tallahassee, FL 32399 

http://www.dcf.state.fl.us/mentalhealth

The Department of Children and Families is the state 

agency that administers Florida’s mental health 

program and is the state mental health authority. The 

Department is under the management of a Secretary 

who reports directly to the Governor. The Assistant 

Secretary for Substance Abuse and Mental Health 

facilitates the integration of substance abuse and 

mental health services and establishes policy direction. 

The Directors for Mental Health and Substance Abuse 

report directly to the Assistant Secretary. Operational 

authority for mental health services is statutorily 

delegated to five regional offices and 20 circuits. Each 

circuit has a Substance Abuse and Mental Health 

Program Office (SAMH). 

Statistics: 

State Population (2006): 18,089,888 

Number of Persons Served (2007): 262,917 

Utilization Rate for Adults: 12 per 1,000 

Utilization Rate for Children: 23.0 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $647.2 million 

Revenue From Medicaid $119.4 million 

Expenditures for Community Mental Health Services (54% of Total 

Mental Health Agency Revenues) $347.9 million 

Per Capita State Mental Health Expenditures $36.56 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services Part of the SMHA 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Florida 45 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in a different state department 

Substance Abuse Agency Located in the same umbrella department as the SMHA 

State Housing Department Located in a different state department 

State Health Department Located in a different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 3 4 7 

Community Mental Health Providers 0 341 341 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Statewide 12 

Supported Employment Statewide 35 

Medication Algorithms (Schizophrenia) Parts of the state 

Medication Algorithms (Bipolar Disorders) Parts of the state 

Family Psychoeducation Parts of the state 10 

Integrated MH/Substance Abuse Services Parts of the state 

Self-Management Parts of the state 38 

Supported Housing Statewide 

Consumer-Operated Services Parts of the state 32 

Therapeutic Foster Care Statewide 18 

Functional Family Therapy Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. State’s share of 

the Medicaid match is 41percent. 

Funding and Characteristics of State Mental Health Agencies, 2007– Florida 46 
The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency 

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA jointly responsible with Medicaid agency 

Evaluating SMHA has no responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Mental health parity laws: 

The state does not mandate mental health insurance benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections No Yes 

Health No Yes 

Housing No Yes 

Education No Yes 

Juvenile Justice No Yes 

Child Welfare No Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Child welfare policy. 

Telemedicine: 

The SMHA promotes the use of telemedicine—one program pilot. 

Electronic Health Records (EHR): 

The SMHA has no EHR activities or plans for state hospitals and community mental health 

programs. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are three SMHA-operated state psychiatric hospitals. 

Funding and Characteristics of State Mental Health Agencies, 2007– Florida 47 
SMHA currently uses its state psychiatric hospital beds for: 

Target Population Long-Term Inpatient (more than 90 days) 

Adults Yes 

Elderly Yes 

Forensic Yes 

The average daily census in FY 2006 for youth was 63 and for adults was 2,541 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is not experiencing a shortage of psychiatric beds. 

Services for Armed Forces veterans and National Guard members: 

Recently the SMHA applied jointly with FVA and received a Federal technical assistance grant 

to work together around the more effective provision of mental health services to veterans and 

their families.

Funding and Characteristics of State Mental Health Agencies, 2007– Florida 48 
GEORGIA 2007 

Division of Mental Health, 

Developmental 

Disabilities, and Addictive 

Diseases 

Department of Human 

Resources 

Two Peachtree Street 

Suite 23-492 

Atlanta, GA 30303

The Georgia Division of Mental Health, Developmental 

Disabilities and Addictive Diseases (DMHDDAD) develops and 

administers services for adults, children, and families in all 159 

counties of the State. The DMHDDAD operates within the 

Department of Human Resources (DHR), together with the 

Division of Aging, the Division of Public Health, the Department of 

Family and Children Services, and others. The DMHDDAD 

provides statewide direction, planning, coordination, consultation, 

technical assistance, and management support to publicly operated 

or funded mental health, substance abuse, and developmental 

disability programs in Georgia. Mental health services are 

primarily administered through contracts and letters of agreement 

with public and private providers. 

Statistics: 

State Population (2006): 9,363,941 

Number of Persons Served (2007): 147,648 

Utilization Rate for Adults: 16 per 1,000 

Utilization Rate for Children: 15 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $444 million 

Revenue From Medicaid $55.3 million 

Expenditures for Community Mental Health Services (54% of Total 

Mental Health Agency Revenues) $241.8 million 

Per Capita State Mental Health Expenditures $48.98 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency 

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Part of SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Shared with another agency 

Funding and Characteristics of State Mental Health Agencies, 2007– Georgia 49 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in a different state department 

Substance Abuse Agency Part of SMHA 

State Housing Department Located in a different state department 

State Health Department Located in the same umbrella department as the SMHA

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 7 0 7 

Community Mental Health Providers 0 147 147 

Private Psychiatric Hospitals NA 2 2 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 1 0 1 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation 

Assertive Community Treatment (ACT) Parts of the state 

Supported Employment Statewide 

Family Psychoeducation Statewide 

Integrated MH/Substance Abuse Services Statewide 

Self-Management Statewide 

Supported Housing Statewide 

Consumer-Operated Services Statewide 

Therapeutic Foster Care Parts of the state 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation Number of Programs 

System of Care Models Available in parts of state 5 

Peer Support Available in parts of state 51 

IFI Available statewide 

Psychosocial Rehabilitation Available statewide 

Note: Blank space indicates the state did not report data for this category. 

Funding and Characteristics of State Mental Health Agencies, 2007– Georgia 50 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. Certified peer 

specialist certification program; partnership with Medical College of Georgia to develop a 

recovery-based training curriculum for psychiatric residents; provided intensive supervision for 

motivational interviewing for persons with co-occurring disorders; offering a financial incentive 

program for employees. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. State’s share 

of the Medicaid match is 62 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency 

Contracting SMHA has no responsibility 

Monitoring SMHA has no responsibility 

Evaluating SMHA has no responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Parents can access all services, including 

residential services, without relinquishment of custody. 

Telemedicine: 

The SMHA promotes the use of telemedicine. The SMHA has developed codes that allow for 

billing for telemedicine. Pilot projects are in development to link jails with psychiatrists through 

telemedicine and to link deaf consumers with practitioners and interpreters. 

Funding and Characteristics of State Mental Health Agencies, 2007– Georgia 51 
Funding and Characteristics of State Mental Health Agencies, 2007– Georgia 52 

Electronic Health Records (EHR): 

The SMHA has no EHR activities or plans for community mental health programs. The SMHA 

is in the process of installing an EHR in state hospitals. The SMHA has some EHR components 

implemented in state hospitals. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are seven SMHA-operated state psychiatric hospitals. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes 

Adolescents Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 59 and for adults was 1,169 receiving state 

psychiatric inpatient care. 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in general hospital specialty unit psychiatric and state psychiatric hospital beds during 

the last year.
HAWAII 2007 

2800 Woodland Drive Suite 

120 

Honolulu, HI 96822 

http://www.hawaii.gov/health 

The State’s Mental Health System is located in the Department 

of Health (DOH), Behavioral Health Administration (BHA). 

Four Divisions comprise the BHA: the Adult Mental Health 

Division (AMHD), the Child and Adolescent Mental Health 

Division (CAMHD), the Alcohol and Drug Abuse Division 

(ADAD), and the Developmental Disabilities Division (DDD). 

CAMHD, ADAD, and DDD contract for all services provided, 

and the AMHD both provides services through the CMHCs and 

contracts for services through approximately thirty-five (35) 

Purchase of Service (POS) providers. 

Statistics: 

State Population (2006): 1,285,498 

Number of Persons Served (2007): 17,147 

Utilization Rate for Adults: 14 per 1,000 

Utilization Rate for Children: 10 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $192.6 million 

Revenue From Medicaid $3.9 million 

Expenditures for Community Mental Health Services (68% of Total 

Mental Health Agency Revenues) $131.2 million 

Per Capita State Mental Health Expenditures $156.67 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Sex Offender Services Part of the SMHA 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Hawaii 53 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in a different state department 

Substance Abuse Agency Located in the same umbrella department as the SMHA 

State Health Department Located in the same umbrella department as the SMHA 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 1 1 2 

Community Mental Health Providers 17 62 79 

Private Psychiatric Hospitals NA 1 1 

General Hospitals With Separate Psychiatric Units 0 1 1 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism used in delivering community mental health services: 

SMHA directly operates and funds community-based programs.

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state 3 

Supported Employment Statewide 

Medication Algorithms (Schizophrenia) Pilot program 

Family Psychoeducation Statewide 

Integrated MH/Substance Abuse Services Statewide 9 

Self-Management Statewide 

Supported Housing Statewide 

Consumer-Operated Services Parts of the state 

Multisystemic Therapy (Conduct Disorder) Parts of the state 

Therapeutic Foster Care Statewide 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation Number of 

Programs 

Dialectical Behavior Therapy Available in parts of state 

Child Welfare League/NTAC Seclusion and Restraint Available in parts of state 6 

Transition to Independence Process Available in parts of state 1 

Culture Enhancements to IMR Available in parts of state 1 

Consumer Assessment Available statewide 1 

Culture Enhancements to Family Psychoeducation Available in parts of state 1 

Note: Blank space indicates the state did not report data for this category. 

Funding and Characteristics of State Mental Health Agencies, 2007– Hawaii 54 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce: transition of youth 

and older adult populations (AMHD); maintain a Practice Development office; Evidence-Based 

Services Committee and Training Committee with numerous initiatives and a comprehensive 

plan; fund university-based training programs in nursing, psychiatry, psychology, social work, 

and research and evaluation (CAMHD). 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid Research and Demonstration 

(1115) waiver. 

State’s share of the Medicaid match is 58 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency 

Writing waiver 

SMHA jointly responsible with Medicaid agency 

(Children’s Division), SMHA has no 

responsibility (Adult Division) 

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

SMHA serves as managed care agent 

SMHA has lead responsibility (Children’s 

Division), SMHA jointly responsible with 

Medicaid agency (Adult Division) 

Mental health parity laws: 

The State mandates mental health insurance benefits. 

These benefits include any mental health and substance abuse service. The following diagnoses 

are included: DSM diagnoses except for epilepsy, senility, mental retardation, and developmental 

disabilities (CAMHD). The mandate includes parity with physical health service benefits. 

Funding and Characteristics of State Mental Health Agencies, 2007– Hawaii 55 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes (Adult Division) 

Health Yes (Adult Division) Yes 

Housing Yes (Adult Division) Yes (Adult Division) 

Education Yes (Children’s Division) Yes 

Juvenile Justice Yes (Children’s Division) Yes (Children’s Division) 

Child Welfare Yes (Children’s Division) Yes (Children’s Division) 

Note: Blank space indicates the state did not report data for this category. 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Provide mental health services regardless of 

custody status, no rejection policy. Actively attempt to keep youth with families, provide 

services to prevent relinquishment (CAMHD). 

Telemedicine: 

The SMHA promotes the use of telemedicine with neighbor islands (AMHD). 

Electronic Health Records (EHR): 

The SMHA has some EHR components implemented in state hospitals and community mental 

health programs. The state does not use a single EHR system for all community mental health 

providers. Local providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one SMHA-operated state psychiatric hospital. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes 

Forensic Yes Yes Yes 

Funding and Characteristics of State Mental Health Agencies, 2007– Hawaii                                      56
State psychiatric hospital patient legal status: 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members; served equally consistent with eligibility criteria (AMHD).

Funding and Characteristics of State Mental Health Agencies, 2007– Hawaii 57 
IDAHO 2007 

Division of Behavioral Health 

Idaho Department of Health and 

Welfare 

450 West State Street, 3rd Floor 

Boise, ID 83702 

http://www.healthandwelfare.idaho.gov

Idaho’s public Community Mental Health Services are 

administered by the Department of Health and Welfare 

in the newly formed Division of Behavioral Health 

Services. Services are delivered through seven 

geographically defined regional programs. Regional 

community mental health centers provide adult and 

children’s mental health service. State-level programs 

provide statewide coordination and technical 

assistance to regional service programs. 

Statistics: 

State Population (2006): 1,466,465 

Number of Persons Served (2007): 23,417 

Utilization Rate for Adults: 14 per 1,000 

Utilization Rate for Children: 22 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $53.9 million 

Revenue From Medicaid $9.4 million 

Expenditures for Community Mental Health Services (57% of Total 

Mental Health Agency Revenues) $30.9 million 

Per Capita State Mental Health Expenditures $37.81 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Responsibility for services is shared with 

another agency 

Brain Impaired Services (including Traumatic 

Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain 

Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in 

Prison/Jail 

Responsibility for services is shared with 

another agency 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Idaho 58 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department as the SMHA 

Substance Abuse Agency Same umbrella department as the SMHA 

State Housing Department Different state department 

State Health Department Same umbrella department as the SMHA 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated

SMHAFunded Total 

State Psychiatric Hospitals 2 0 2 

Community Mental Health Providers 7 0 7 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 1 0 1 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly operates community-based programs. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Statewide 7 

Supported Employment Parts of the state 

Supported Housing Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation 

Forensic Assertive Community Treatment (FACT) Available statewide 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce: university 

partnership in Children’s Mental Health. 

Managed behavioral healthcare: 

Only substance abuse services are being delivered via managed care. State’s share of the 

Medicaid match is 30 percent. 

Funding and Characteristics of State Mental Health Agencies, 2007– Idaho 59 
The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency 

Writing waiver SMHA has no responsibility 

Contracting SMHA jointly responsible with Medicaid agency 

Monitoring SMHA jointly responsible with Medicaid agency 

Evaluating SMHA jointly responsible with Medicaid agency 

SMHA serves as managed care agent SMHA has lead responsibility 

Mental health parity laws: 

The state does not mandate mental health insurance benefits. 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: The Children’s Mental Health Services Act is a 

voluntary act that prevents relinquishment of custody. Custody relinquishment on emergency is 

still provided for but encourages the move to voluntary. 

Telemedicine: 

The SMHA promotes the use of telemedicine. 2006, Service Plan Component; Region 2, Latah 

County; Telemedicine 2007; Clearwater Economic Development Association; Region 2, 

Telemedicine. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in community mental health programs. The 

SMHA is in the process of installing an EHR in state hospitals. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are two SMHA-operated state psychiatric hospitals. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adolescents Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in general hospital specialty unit psychiatric beds in the last 5 years.

Funding and Characteristics of State Mental Health Agencies, 2007– Idaho 60 
ILLINOIS 2007 

Illinois Department of 

Human Services 

Division of Mental Health 

160 N. La Salle Street 

10th Floor 

Chicago, IL 60601 

http://www.dhs.state.il.us 

The Illinois Department of Human Services Division of Mental 

Health (DMH) administers community health and prevention 

programs; oversees programs for persons with developmental 

disabilities, mental health and substance abuse problems; and 

provides rehabilitation services and helps low-income persons 

with financial support, employment and training services, child 

care and other family services. The DMH is organized into five 

Comprehensive Community Service Regions (CCSR). Through 

these Regions, the DMH operates 9 state hospitals and contracts 

with 162 community mental health providers across the state. 

Statistics: 

State Population (2006): 12,831,970 

Number of Persons Served (2007): 179,580 

Utilization Rate for Adults: 15 per 1,000 

Utilization Rate for Children: 12 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $1 billion 

Revenue From Medicaid $401.1 million 

Expenditures for Community Mental Health Services (70% of Total 

Mental Health Agency Revenues) $711.3 million 

Per Capita State Mental Health Expenditures $80.15 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Illinois 61 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in a different state department 

Substance Abuse Agency Located in the same umbrella department as the SMHA 

State Housing Department Located in a different state department 

State Health Department Located in a different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 10 0 10 

Community Mental Health Providers 0 151 151 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 28 28 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds, but does not operate local community-based agencies 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state 50 

Supported Employment Pilot program 11 

Medication Algorithms (Schizophrenia) Parts of the state 

Medication Algorithms (Bipolar Disorders) Parts of the state 

Integrated MH/Substance Abuse Services Pilot program 3 

Self-Management Parts of the state 

Consumer-Operated Services Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 50 percent. 

Funding and Characteristics of State Mental Health Agencies, 2007– Illinois 62 
The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid 

agency 

Mental health parity laws: 

The state mandates mental health insurance benefits. 

These benefits include any mental health and substance abuse service. The mandate includes 

parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid No Yes 

Corrections Yes Yes 

Health Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare No Yes 

Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. Pilot will be initiated in rural areas of the state 

focusing on delivery of service to children and adolescents. The Governor also just signed a bill 

requiring the state Medicaid agency to reimburse for delivery of telepsychiatry services. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are 10 SMHA-operated state psychiatric hospitals. 

Funding and Characteristics of State Mental Health Agencies, 2007– Illinois 63 
The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adolescents Yes 

Adults Yes Yes Yes 

Forensic Yes Yes 

The average daily census in FY 2006 for youth was 18 and for adults was 1,422 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in general hospital specialty unit psychiatric beds in the last year. 

Funding and Characteristics of State Mental Health Agencies, 2007– Illinois 64 
INDIANA 2007 

Division of Mental Health and 

Addiction 

Family and Social Services 

Administration 

402 W. Washington Street, Room 

W353 

Indianapolis, IN 46204 

http://www.in.gov/fssa/servicemental/

The Indiana mental health system provides services in 

all 92 counties of the state. The Hoosier Assurance Plan, 

adopted in 1994, is the basis on which the Division of 

Mental Health and Addiction (DMHA) relates to and 

funds the Indiana mental health service system. It guides 

the management of public funds earmarked for mental 

health services, assuring that priority will be given to 

individuals in greatest need. Under this plan, DMHA 

acts as a purchasing agent, contracting with qualified 

managed care providers offering an array of 

individualized mental health and addiction care. The 

Division has statutory authority for 6 state-operated 

facilities, and contracts with 30 private community 

mental health centers and a network of addiction 

providers. The Hoosier Assurance Plan eliminated the 

traditional geographic service areas, resulting in 

consumers having choice of two or more services 

providers in many areas of the state. 

Statistics: 

State Population (2006): 6,313,520 

Number of Persons Served (2007): 87,641 

Utilization Rate for Adults: 12 per 1,000 

Utilization Rate for Children: 19 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $518.7 million 

Revenue From Medicaid $393.4 million 

Expenditures for Community Mental Health Services (66% of Total 

Mental Health Agency Revenues) $344.7 million 

Per Capita State Mental Health Expenditures $82.79 

Funding and Characteristics of State Mental Health Agencies, 2007– Indiana 65 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Responsibility for services is shared with 

another agency 

Adult Forensic Mental Health Services Responsibility for services is shared with 

another agency 

Brain Impaired Services (including Traumatic 

Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain 

Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Responsibility for services is shared with 

another agency 

Services to Persons With Mental Illness in 

Prison/Jail No responsibility 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department as the SMHA 

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 6 0 6 

Community Mental Health Providers 0 30 30 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Funding and Characteristics of State Mental Health Agencies, 2007– Indiana 66 
Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state 30 

Supported Employment Parts of the state 28 

Integrated MH/Substance Abuse Services Parts of the state 6 

Self-Management Parts of the state 8 

Multisystemic Therapy (Conduct Disorder) Parts of the state 

Therapeutic Foster Care Parts of the state 

Functional Family Therapy Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation Number of 

Programs 

Child and Family Wraparound Teams Available in parts of state 50 

Cognitive Behavior Therapy Available in parts of state 

Psychosocial Rehabilitation (Clubhouses) Available in parts of state 14 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the mental health workforce. DMHA, 

through the Mental Health Commission, has proposed licensure for addiction counselors. Indiana 

does not currently have any state licensure for addiction treatment providers. The Indiana Family 

Social Service Agency (FSSA), under which DMHA is housed, funded a study through Indiana 

University’s School of Public and Environmental Affairs. This comprehensive study and focus 

group activity was charged with developing recommendations for improving Indiana’s health 

delivery system. Special attention was paid to workforce issues, including those specific to 

mental health and addiction. Recommendations from the report will inform legislative and policy 

decisions in the coming year. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. 

State’s share of the Medicaid match is 37 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid 

agency 

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA has no responsibility 

Evaluating SMHA has no responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Funding and Characteristics of State Mental Health Agencies, 2007– Indiana 67 
Mental health parity laws: 

The state mandates mental health insurance benefits that provide mental health parity if the 

carrier provides mental health benefits.

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: State law was passed to ensure parents would 

not be forced to relinquish custody in order to receive services. However, there was no funding 

connected to the law. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals and community mental 

health programs. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are six SMHA-operated state psychiatric hospitals. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 94 and for adults was 1,021 receiving state 

psychiatric inpatient care. 

Funding and Characteristics of State Mental Health Agencies, 2007– Indiana 68 
Telemedicine: 

The SMHA does not promote the use by telemedicine. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in private psychiatric hospital beds in the last year. 

Funding and Characteristics of State Mental Health Agencies, 2007– Indiana 69 
IOWA 2007 

Division of Mental Health 

and Disability Services 

Department of Human 

Services 

1305 E. Walnut 

Hoover Building 

5th Floor 

Des Moines, IA 50319

The Department of Human Services, Division of Mental Health and 

Disability Services is the State Mental Health Authority for Iowa. 

The system of community-based services for adults with a mental 

illness is uniquely decentralized and remains largely under the 

control of county governments. The responsibility of mental health 

services for children and adolescents is centralized at that state 

level with a number of state agencies, including the state mental 

health authority and state child welfare, Juvenile Justice, the 

Department of Education, the Department of Public Health, and 

county governments providing and managing various service 

programs. 

Statistics: 

State Population (2006): 2,982,085 

Number of Persons Served (2007): 81,803 

Utilization Rate for Adults: 22 per 1,000 

Utilization Rate for Children: 45 per 1,000 

Revenues and expenditures:

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $235.5 million 

Revenue From Medicaid $98.8 million 

Expenditures for Community Mental Health Services (87% of Total 

Mental Health Agency Revenues) $204.3 million 

Per Capita State Mental Health Expenditures $79.44 

Funding and Characteristics of State Mental Health Agencies, 2007– Iowa 70 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Responsibility for services is shared with 

another agency 

Adult Forensic Mental Health Services No responsibility 

Brain Impaired Services (including Traumatic 

Brain Injuries) 

Responsibility for services is shared with 

another agency 

Alzheimer’s Disease and Organic Brain 

Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Responsibility for services is shared with 

another agency 

Services to Persons With Mental Illness in 

Prison/Jail No responsibility 

Sex Offender Services Part of the SMHA 

State Mental Hospitals Part of umbrella agency 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in the same umbrella department as the SMHA 

Substance Abuse Agency Located in a different state department 

State Housing Department Located in a different state department 

State Health Department Located in a different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 0 4 4 

Community Mental Health Providers 0 62 62 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Evidence-based services: 

Evidence-Based Practice Implementation 

Assertive Community Treatment (ACT) Parts of the state 

Supported Employment Parts of the state 

Integrated MH/Substance Abuse Services Parts of the state 

Supported Housing Parts of the state 

Funding and Characteristics of State Mental Health Agencies, 2007– Iowa 71 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; self-employment 

initiatives. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. 

State’s share of the Medicaid match was unreported. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid 

agency 

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA jointly responsible with Medicaid 

agency 

Evaluating SMHA jointly responsible with Medicaid 

agency 

SMHA serves as managed care agent SMHA has no responsibility 

Mental health parity laws: 

The state mandates mental health insurance benefits. Only benefits for specific mental health 

diagnoses are included. The mandate does not include parity with physical health service 

benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Housing Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Have a Medicaid Children’s mental health 

waiver that started July 1, 2005; longer necessary for parents to relinquish custody for PMIC 

admissions. 

Telemedicine: 

The SMHA promotes the use of telemedicine. 

Funding and Characteristics of State Mental Health Agencies, 2007– Iowa 72 
Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in community mental health programs. The 

state is in the process of installing an EHR in state hospitals. The state does not use a single EHR 

system for all community mental health providers. 

State psychiatric hospital: 

There are four state-operated state psychiatric hospitals within the same umbrella agency as the 

SMHA, which is responsible for funding and/or delivery of community-based mental health 

services. 

The SMHA uses its state psychiatric hospitals beds for: 

Target Population Acute Inpatient (fewer than 30 

days) 

Long-Term Inpatient (more than 

90 days) 

Children Yes 

Adolescents Yes 

Adults Yes 

Elderly Yes Yes 

The average daily census in FY 2006 for youth was 30 and adults was 95 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages:

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in private psychiatric hospital beds in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard to assure the provision of services to meet 

the mental health needs of veterans and National Guard members.

Funding and Characteristics of State Mental Health Agencies, 2007– Iowa 73 
KANSAS 2007 

Disability and Behavioral 

Health Services 

Department of Social and 

Rehabilitation Services 

915 SW Harrison 

9th Floor 

Topeka, KS 66612-1570 

http://www.srskansas.org/h

cp/MHmain.htm 

The mission of the Division of Health Care Policy’s Mental Health 

unit is to promote and ensure high quality mental health care, 

consisting of a comprehensive array of treatments and supports 

available to all individuals in Kansas. Kansas has contracted with 

a newly formed entity, Kansas Health Solutions (KHS), to provide 

Medicaid-reimbursed mental health services. KHS is a 

corporation formed by the Association of Community Mental 

Health Centers (CMHC) and is governed by Federal managed 

care requirements and monitored by SRS/MH. KHS began 

operation on July 1, 2007. In order to afford the same 

accountability for service and addressing unmet need to the nonMedicaid population, SRS/MH has contracted with each CMHC to 

meet the same requirements articulated in the managed care 

contract. In Kansas, target populations are adults with severe and 

persistent mental illness and children with serious emotional 

disturbance. The Division of Health Care Policy also oversees the 

operation of three state mental health hospitals. 

Statistics: 

State Population (2006): 2,764,075 

Number of Persons Served (2007): 103,790 

Utilization Rate for Adults: 34 per 1,000 

Utilization Rate for Children: 47 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $253.7 million 

Revenue From Medicaid $155.8 million 

Expenditures for Community Mental Health Services (73% of Total 

Mental Health Agency Revenues) $185 million 

Per Capita State Mental Health Expenditures $92.81 

Funding and Characteristics of State Mental Health Agencies, 2007– Kansas 74 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Shared with another agency 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services Part of the SMHA 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Different state department 

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 3 0 3 

Community Mental Health Providers 0 26 26 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

NA = not applicable 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Supported Employment Parts of the state 12 

Integrated MH/Substance Abuse Services Parts of the state 11 

Supported Housing Parts of the state 

Consumer-Operated Services Statewide 23 

Therapeutic Foster Care Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. 

State’s share of the Medicaid match is 40 percent. 

Funding and Characteristics of State Mental Health Agencies, 2007– Kansas 75 
The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has lead responsibility 

Writing waiver SMHA jointly responsible with Medicaid 

agency 

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

SMHA serves as managed care agent SMHA has lead responsibility 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice No Yes 

Child Welfare No Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: SMHA system and child welfare system have 

policies to eliminate the need for custody relinquishment. These include child welfare familycentered system of care, mental health reform, and mental health initiative 2000. 

Telemedicine: 

The SMHA promotes the use of telemedicine: supporting the expansion of telemedicine through 

partner Association of CMHC’s and the Mental Health Consortium. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are three SMHA-operated state psychiatric hospitals. 

Funding and Characteristics of State Mental Health Agencies, 2007– Kansas 76 
Funding and Characteristics of State Mental Health Agencies, 2007– Kansas 77 

SMHA currently uses its state psychiatric hospital beds for: 

Target Population Acute Inpatient (fewer than 30 

days) 

Intermediate Inpatient 

(30–90 days) 

Children Yes Yes 

Adolescents Yes Yes 

Adults Yes Yes 

Elderly Yes Yes 

The average daily census in FY 2006 for youth was 25 and for adults was 264 receiving state 

psychiatric inpatient care. 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in general hospital specialty unit psychiatric beds in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Departments of Veterans 

Affairs and Defense to assure the provision of services to meet the mental health needs of 

veterans and National Guard members. All groups listed participate on the veterans and families 

task force to improve services to all veterans and families
KENTUCKY 2007 

KDMHMRS 

100 Fair Oaks Lane 4E-A 

Frankfort, KY 40601 

Department for Mental Health and Mental Retardation 

Services (KDMHMRS) is identified by Kentucky Revised 

Statute (KRS) 194.030 as the primary state agency for 

developing and administering programs for the prevention, 

detection, and treatment of mental health, mental retardation, 

and substance abuse disorders. The DMHMRS is a 

Department within the Cabinet for Health and Family 

Services. The Commissioner of the Department for Mental 

Health is responsible directly to an Undersecretary for Health 

who also oversees the Departments for Public Health and 

Medicaid Services. Thus, the Secretary of the Cabinet, through 

the Undersecretary for Health, exercises authority over 

multiple departments that are directly related to both primary 

healthcare and behavioral healthcare. 

Statistics: 

State Population (2006): 4,206,074 

Number of Person Served (2007): 133,692 

Utilization Rate for Adults: 28 per 1,000 

Utilization Rate for Children: 48 per 1,000 

Revenue and expenditure: 

Revenue and Expenditure (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $208.4 million 

Revenue From Medicaid $60 million 

Expenditure for Community Mental Health Services (46% of Total 

SMHA revenues) 

$95.3 million 

Per Capita State Mental Health Spending $50.22 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Shared with another agency 

Funding and Characteristics of State Mental Health Agencies, 2007– Kentucky 78 
Location of other state agencies in relation to the SMHAs: 

Agency Location 

State Medicaid Agency Same umbrella department 

State Housing Agency Different state department 

State Health Department Same umbrella department 

Substance Abuse Agency Part of the SMHA 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 3 1 4 

Community Mental Health Providers 0 14 14 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 1 1 

Nursing Homes and Other ICF-MI and SNF Providers 2 0 2 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practices Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state 3 

Supported Employment Parts of the state 3 

Medication Algorithms (schizophrenia) Parts of the state 2 

Family Psychoeducation Parts of the state 9 

Integrated Mental Health/Substance Abuse Services Parts of the state 7 

Self-Management Parts of the state 10 

Supported Housing Parts of the state 9 

Consumer-Operated Services 6 

Multisystem Therapy (Conduct Disorder) Pilot program 2 

Therapeutic Foster Care Parts of the state 6 

Functional Family Therapy Parts of the state 1 

Note: Blank space indicates the state did not report data for this category. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 30 percent. 

Funding and Characteristics of State Mental Health Agencies, 2007– Kentucky 79 
The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has no responsibility 

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA has no responsibility 

Evaluating SMHA has no responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Mental health parity laws: 

The State mandates mental health insurance benefits. These benefits include any mental health 

service, but not substance abuse services. The mandate includes parity with physical health 

service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Juvenile Justice No Yes 

Child Welfare No Yes 

Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. There were no children who had their parents’ custody 

relinquished in 2007 in order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine; funding provided to four CMHCs in the western 

part of the state for telehealth equipment under the DIVERTS program (to reduce admissions to 

Western State Hospital). 

Electronic Health Records (EHR): 

The SMHA has some EHR components implemented in state hospitals and community mental 

health programs. The state does not use a single EHR system for all community mental health 

providers. Local providers use a variety of EHR systems. 

State psychiatric hospital: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are three SMHA-operated state psychiatric hospitals.

Funding and Characteristics of State Mental Health Agencies, 2007– Kentucky 80 
The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 10 and adults was 489 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There has been decline 

seen in general hospital specialty unit psychiatric beds in the last 5 years.

Funding and Characteristics of State Mental Health Agencies, 2007– Kentucky 81 
LOUISIANA 2007 

628 N. 4th Street 

4th Floor, POB 4049 

Baton Rouge, LA 70821 

http://www.dhh.louisiana.gov/offices/?ID=62

The Office of Mental Health (OMH) operates 

within the Department of Health and Hospitals 

(DHH) alongside agencies of the Office of Public 

Health, the Office of Addictive Disorders, the 

Office for Citizens with Developmental 

Disabilities, and the Office of Management and 

Finance (including the State Medicaid agency). 

The administration of the Louisiana mental 

health care system is changing from interrelated 

geographic areas and regions to a system of 

independent health care districts or authorities 

under the general administration of OMH. 

Statistics: 

State Population (2006): 4,287,768 

Number of Persons Served (2007): 47,341 

Utilization Rate for Adults: 12 per 1,000 

Utilization Rate for Children: 7 per 1,000 

Revenue and expenditure: 

Revenue and Expenditure (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $258.5 million 

Revenue From Medicaid $105.6 million 

Expenditure for Community Mental Health Services (41% of Total 

SMHA Revenues) $106.3 million 

Per Capita State Mental Health Spending $57.59 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services* Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail Part of the SMHA 

Sex Offender Services Part of the SMHA 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

*SMHA has responsibility for elderly but no formal programs at present. 

Funding and Characteristics of State Mental Health Agencies, 2007– Louisiana 82 
Location of other state agencies in relation to the SMHAs: 

Agency Location 

State Medicaid Agency Same umbrella department 

Substance Abuse Agency Same umbrella department 

State Housing Agency Different state department 

State Health Department Same umbrella department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 5 5 5 

Community Mental Health Providers 40 40 40 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 3 0 3 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly operates local community-based agencies. 

Evidence-based services: 

Evidence-Based Practices Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state 10 

Supported Employment Parts of the state 9 

Medication Algorithms (Schizophrenia) Parts of the state 1 

Medication Algorithms (Bipolar Disorders) Parts of the state 1 

Family Psychoeducation Parts of the state 4 

Integrated Mental Health/Substance Abuse Services Parts of the state 10 

Self-Management Parts of the state 4 

Supported Housing Parts of the state 2 

Consumer-Operated Services* Parts of the state 19 

Multisystem Therapy (Conduct Disorder) Parts of the state 2 

Therapeutic Foster Care 1 

Functional Family Therapy 1 

Note: Blank space indicates the state did not report data for this category. 

*Consumer Resource Centers 

Funding and Characteristics of State Mental Health Agencies, 2007– Louisiana 83 
Emerging evidence-based and innovative practices: 

Evidence-Based Practices Number of Programs 

Child Adolescent Response Team 6 

Early Childhood Supports and Services 10 

Louisiana Youth Extension Teams 1 

Crisis Intervention Teams 2 

School-Based Mental Health Services 9 

Family Preservation Services 3 

Juvenile Justice Diversion Programs 6 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; co-occurring 

training has occurred across the state (Basic and Advanced). Web-based essential learning is 

being developed, giving staff access to members’ courses and including other offices (AHD and 

OCDD); this project will enhance credentialing and competency-based staff development; 

Person-Centered training; Mental Health Leadership; Coming Together for recovery. 

Managed behavioral healthcare: 

Medicaid mental health rehabilitation services are being delivered via managed care. State’s 

share of the Medicaid match is 30 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has lead responsibility 

Writing waiver SMHA has no responsibility 

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

SMHA serves as managed care agent SMHA has lead responsibility 

Mental health parity laws: 

The state mandates mental health insurance benefits. These benefits include any mental health 

service, but not substance abuse services. The mandate includes parity with physical health 

service benefits. 

Funding and Characteristics of State Mental Health Agencies, 2007– Louisiana 84 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections No Yes 

Health Yes Yes 

Housing Yes Yes 

Education No Yes 

Juvenile Justice Yes Yes 

Child Welfare No Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: A parent does not have to relinquish custody for 

children to receive mental health services. There are times, however, when a court will place a 

youth into DHH custody for treatment, etc. (e.g., competency, restoration). The SMHA follows 

its admission and treatment policy procedures. There were no children in the SMHA system who 

had their parents’ custody relinquished in 2007 in order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals and community mental 

health programs. The SMHA is in the process of installing an EHR in community mental health 

centers. 

State psychiatric hospital: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are five SMHA-operated state psychiatric hospitals. 

Funding and Characteristics of State Mental Health Agencies, 2007– Louisiana 85 
The SMHA uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 49 and adults was 866 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There has been a 

decline seen in general hospital specialty unit psychiatric beds in the last 5 years.

Funding and Characteristics of State Mental Health Agencies, 2007– Louisiana 86 
MAINE 2007 

DHHS, 11 SHS 

Marquadt Building 

2nd Floor 

Augusta, ME 04330 

http://www.maine.gov/dhhs/bds/

The Maine Department of Health and Human Services 

(DHHS), as the designated State Public Mental Health 

Authority, is responsible for the integration of mental health 

with health care in general, and with public health efforts. 

Within DHHS, the Office of Adult Mental Health Services 

(OAMHS) performs these functions through coordinated 

efforts of a central office and three regional offices. A 

primary responsibility of the Mental Health Authority is to 

develop and maintain a system of adult community mental 

health treatments, services, and supports for people age 18 

and older. The Office of Adult Mental Health Services reports 

to the Deputy Commissioner for Integrated Services and 

collaborates with the Office of Child and Family Services, the 

Office of Substance Abuse Services, and others. The focal 

point for children’s mental health is the Children’s 

Behavioral Health Services Program within DHHS. 

Children’s Behavioral Health Services supports and serves 

children, age birth through 5, who have developmental 

disabilities or demonstrate developmental delays, and 

children and adolescents, age 0–20, who have treatment 

needs related to mental illness, mental retardation, autism, 

developmental disabilities, or emotional and behavioral 

needs. 

Statistics: 

State Population (2006): 1,321,574 

Number of Persons Served (2007): 48,696 

Utilization Rate for Adults: 30 per 1,000 

Utilization Rate for Children: 62 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $180.3 million 

Revenue From Medicaid $123.8 million 

Expenditure for Community Mental Health Services (69% of Total 

SMHA Revenues) $124.2 million 

Per Capita State Mental Health Spending $137.15 

Funding and Characteristics of State Mental Health Agencies, 2007– Maine 87 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of SMHA 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department 

Substance Abuse Agency Same umbrella department 

State Housing Department Different state department 

State Health Department Same umbrella department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 2 0 2 

Community Mental Health Providers 1 117 118 

Private Psychiatric Hospitals NA 2 2 

General Hospitals With Separate Psychiatric Units 0 8 8 

Nursing Homes and Other ICF-MI and SNF Providers 1 0 1 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly contracts with community-based programs.

Funding and Characteristics of State Mental Health Agencies, 2007– Maine 88 
Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state 15 

Supported Employment Statewide 

Family Psychoeducation Parts of the state 1 

Integrated MH/Substance Abuse Services Parts of the state 

Self-Management Parts of the state 

Supported Housing Pilot program statewide 

Multisystemic Therapy (Conduct Disorder) Parts of the state 5 

Therapeutic Foster Care Statewide 12 

Functional Family Therapy Parts of the state 4 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation Number of Programs

Trauma Informed Services Parts of the state 1 

Children’s Assertive Community Tx 

Approach Parts of the state 5 

Collaborative Problem Solving (Ross Green) Parts of the state 2 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; multiple training 

initiatives at all levels of staffing; continue to update training curricula for direct support workers 

and community support workers to reflect a recovery perspective and to support evidence-based 

practices. Piloted a training curriculum for peer support workers and plan to expand the 

availability of peer support in emergency departments, on warm lines, at peer centers, and other 

settings across the state. Recently completed a fidelity review of ACT teams and supported 

employment. 

Managed behavioral healthcare: 

Neither Mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 37 percent. Contract negotiations are under way with an ASO for 

behavioral health services for utilization review and prior authorization. 

Mental health parity laws: 

The state mandates mental health insurance benefits. Only benefits for specific mental health 

diagnoses are included: psychotic disorders, dissociative disorders, mood disorders, anxiety 

disorders, personality disorders, paraphilias, ADHD, PDD, tic disorders, eating disorders, and 

substance abuse disorders. The mandate includes parity with physical health service benefits.

Funding and Characteristics of State Mental Health Agencies, 2007– Maine 89 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes 

Health Yes 

Housing Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Note: Blank space indicates the state did not report data for this category. 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Mental health services are available to all 

Maine children that meet medical necessity regardless of custody status. There were no children 

who had their parents’ custody relinquished in 2007 in order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. Telemedicine has been made available in 

correctional facilities, psychiatric hospitals, outpatient mental health facilities, and rural settings 

as well as in all departmental offices to enable mental health services to be more readily 

available to areas that lack those services. 

Electronic Health Records (EHR): 

The SMHA is in the process of installing an EHR in state hospitals and community mental health 

programs. The SMHA has some EHR components implemented in state hospitals and 

community mental health programs. The state does not use a single EHR system for all 

community mental health providers. Local providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are two SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adolescents No No No 

Adults Yes Yes Yes 

Forensic Yes Yes 

The average daily census in FY 2006 for adults was 86 receiving state psychiatric inpatient care. 

The state psychiatric hospitals do not serve youth. 

Funding and Characteristics of State Mental Health Agencies, 2007– Maine 90 
Funding and Characteristics of State Mental Health Agencies, 2007– Maine 91 

Psychiatric inpatient bed shortages: 

There have been declines in general hospital specialty unit psychiatric beds in the last year. The 

state is not experiencing a shortage of psychiatric beds. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the State National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members; Military Adjustment Program (MAP) for soldiers and their families 

both predeployment and upon return from active service. 
MARYLAND 2007 

Spring Grove Hospital 

Dix Building 

55 Wade Avenue 

Catonsville, MD 21228 

http://www.dhmh.state.md.us/MHA

http://www.MAPS-MD.com 

 

The Mental Hygiene Administration (MHA), the division 

of the State of Maryland Department of Health and Mental 

Hygiene is responsible for overseeing the delivery of 

public mental health services in the state. Maryland 

operates the majority of its public mental health system 

under a Medicaid 1115 Waiver. Specialty mental health 

care is carved out from physical care and is administered 

by MHA. The system is managed in collaboration with 

Core Service Agencies (CSAs), entities at the local level 

that, in collaboration with MHA, develop and manage a 

coordinated network of Maryland public mental health 

services. An administrative Services Organization assists 

MHA and the CSAs in the management of the system.

Statistics: 

State Population (2006): 5,615,727 

Number of Persons Served (2007): 92,738 

Utilization Rate for Adults: 12 per 1,000 

Utilization Rate for Children: 31 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $776.5 million 

Revenue From Medicaid $181 million 

Expenditure for Community Mental Health Services (68% of Total 

SMHA Revenues) $526.2 million 

Per Capita State Mental Health Spending $139.7 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of SMHA 

Elderly Mental Health Services Part of SMHA 

Adult Forensic Mental Health Services Part of SMHA 

Brain Impaired Services (including Traumatic 

Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain 

Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Part of SMHA 

Services to Persons With Mental Illness in 

Prison/Jail Shared with another agency 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Maryland 92 
Services Arena Responsibility 

Community Mental Health Program Part of SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department 

Substance Abuse Agency Same umbrella department 

State Housing Department Different state department 

State Health Department Same umbrella department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 10 10 

Community Mental Health Providers 0 375 375 

Private Psychiatric Hospitals NA 3 3 

NA = not applicable 

Primary mechanism in delivering mental health services:

SMHA directly funds but does not operate local community-based agencies.

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state 7 

Supported Employment Parts of the state 20 

Family Psychoeducation Parts of the state 3 

Integrated MH/Substance Abuse Services Pilot program in part of the state 

Self-Management Parts of the state 3 

Supported Housing Statewide 83 

Consumer-Operated Services Statewide 

Multisystemic Therapy (Conduct Disorder) Pilot program 3 

Therapeutic Foster Care Parts of the state 6 

Functional Family Therapy Pilot program 5 

Note: Blank space indicates the state did not report data for this category. 

Funding and Characteristics of State Mental Health Agencies, 2007– Maryland 93 
Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation Number of Programs 

Child Psychiatric Rehabilitation Statewide 

Seclusion and Restraint Parts of the state 5 

Respite Parts of the state 84 

Adult Partial Capitation Parts of the state 2 

PATCH Project in Senior Housing Parts of the state 1 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid Research and Demonstration 

(1115) waiver. State’s share of the Medicaid match is 50 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has lead responsibility 

Writing waiver SMHA has joint responsibility with Medicaid 

agency 

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

SMHA serves as managed care agent SMHA has lead responsibility 

Mental health parity laws: 

The state mandates mental health insurance benefits. These benefits include any mental health 

service, but not substance abuse services. The mandate includes parity with physical health 

service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Funding and Characteristics of State Mental Health Agencies, 2007– Maryland 94 
Funding and Characteristics of State Mental Health Agencies, 2007– Maryland 95 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Executive order and statute provide for 

voluntary placement agreement by family with Department of Human Resources (Child Welfare 

Agency). 

Telemedicine: 

The SMHA promotes the use of telemedicine. Telemedicine used in several detention centers. 

Telemedicine case conferencing used among child and adolescent facilities. Program in 

conjunction with Johns Hopkins Hospital for Adolescent Services with Regional Institutes for 

Children/Adolescents and Finance Center’s adolescent program. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in community mental health programs. The 

SMHA is in the process of installing an EHR in state hospitals. The state does not use a single 

EHR system for all community mental health providers. Local providers use a variety of EHR 

systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are 10 SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in state 

psychiatric hospital beds in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members; developed a pilot program with the Maryland National Guard, the 

Maryland Defense Force, the Maryland, Virginia, and the Federal VA Pilot program provides 

training for the Maryland National Guard Family Readiness Program for recognizing signs of 

PTSD of returning veterans. 
MASSACHUSETTS 2007 

25 Staniford Street 

Boston, MA 02114 

http://www.mass.gov

The Massachusetts Department of Mental Health (DMH) 

completed a three-phase process to develop a comprehensive 

Strategic Plan. The overarching goals were to: transform the 

mental health system; incorporate equity, individual, family 

and recovery-oriented values into the system redesign; and 

improve overall quality.

Statistics: 

State Population (2006): 6,437,193 

Number of Persons Served (2007): 27,297 

Utilization Rate for Adults: 5 per 1,000 

Utilization Rate for Children: 2 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $685.6 million

Revenue From Medicaid $129.3 million 

Expenditure for Community Mental Health Services (81.0% of 

Total SMHA Revenues) $552.3 million 

Per Capita State Mental Health Spending $106.64 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency 

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of SMHA

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department

Substance Abuse Agency Same umbrella department 

State Housing Department Different state department 

State Health Department Same umbrella department 

Funding and Characteristics of State Mental Health Agencies, 2007– Massachusetts 96 
The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 10 0 10 

Community Mental Health Providers 6 0 6 

Primary mechanism in delivering mental health services: 

SMHA directly operates community-based programs. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Statewide 15 

Supported Employment Statewide 

Medication Algorithms (Schizophrenia) Statewide 

Medication Algorithms (Bipolar Disorders) Statewide 

Family Psychoeducation Statewide 1 

Integrated MH/Substance Abuse Services Statewide 

Self-Management Statewide 

Supported Housing Statewide 

Consumer-Operated Services Statewide 

Multisystemic Therapy (Conduct Disorder) Parts of the state 5 

Therapeutic Foster Care Statewide 12 

Functional Family Therapy 4 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation 

Restraint reduction using NTAC principle and train Available statewide 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; consolidated 

overall responsibility for education and training of mental health workforce into Central Office. 

Regular trainings are held on various topics and online courses are available and encouraged. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid Research and Demonstration 

(1115) waiver. State’s share of the Medicaid match is 50 percent. 

Funding and Characteristics of State Mental Health Agencies, 2007– Massachusetts 97 
The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has joint responsibility with medicaid 

agency 

Writing waiver SMHA has joint responsibility with medicaid 

agency 

Contracting SMHA has joint responsibility with medicaid 

agency 

Monitoring SMHA has joint responsibility with medicaid 

agency 

Evaluating SMHA has joint responsibility with medicaid 

agency 

SMHA serves as managed care agent SMHA has joint responsibility with medicaid 

agency 

Mental health parity laws: 

The state mandates mental health insurance benefits. Parity is limited to diagnoses enumerated in 

the legislation (e.g., biological illnesses). 

The mandate includes parity with physical health service benefits.

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections No Yes 

Health Yes Yes 

Housing Yes Yes 

Education No Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Child welfare law changes in last few years to 

allow for voluntary placement without relinquishment of custody. 

Telemedicine: 

The SMHA promotes the use of telemedicine.

Funding and Characteristics of State Mental Health Agencies, 2007– Massachusetts 98 
Electronic Health Records (EHR): 

The SMHA has some EHR components implemented in state hospitals and community mental 

health programs. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are 10 SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes 

Adolescents Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 53 and for adults was 854 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Note: Percentage may not total 100 because of rounding. 

Psychiatric inpatient bed shortages: 

There have been declines in state psychiatric hospital beds in the last 5 years. The state is not 

experiencing a shortage of psychiatric beds. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the Federal Department of Veterans Affairs to assure the provision 

of services to meet the mental health needs of veterans and National Guard members; working 

with State Department of Veterans Services. 

Funding and Characteristics of State Mental Health Agencies, 2007– Massachusetts 99 
MICHIGAN 2007 

320 South Walnut Street 

Lansing, MI 48913 

http://www.Michigan.Gov/MDCH

In Michigan, Medicaid funds for mental health, substance 

abuse, and developmental disability services are contracted 

by the Michigan Department of Community Health 

(MDCH) with 18 regional Prepaid Inpatient Health Plans 

(PIHPs), which consist of a single Community Mental 

Health Services Program (CMHSP) in large counties, or 

affiliations of CMHSPs in less populous regions. Other 

public funds for mental health and developmental 

disabilities are contracted by MDCH with 46 CMHSPs. 

Other public funds for substance abuse services are 

contracted by MDCH with 16 regional Substance Abuse 

Coordinating Agencies.

Statistics: 

State Population (2006): 10,095,643 

Number of Persons Served (2007): 207,407 

Utilization Rate for Adults: 21 per 1,000 

Utilization Rate for Children: 18 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $973.5 million

Revenue From Medicaid $600.9 million 

Expenditure for Community Mental Health Services (77% of Total 

SMHA Revenues) $749 million 

Per Capita State Mental Health Spending $96.4 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Shared with another agency 

Brain Impaired Services (including Traumatic Brain 

Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Michigan 100 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department

Substance Abuse Agency Same umbrella department

State Housing Department Different state department 

State Health Department Same umbrella department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 6 0 6 

Community Mental Health Providers 0 46 46 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Statewide 88 

Supported Employment Parts of the state 

Medication Algorithms (Schizophrenia) Pilot program 2 

Medication Algorithms (Bipolar Disorders) Pilot program 

Family Psychoeducation Statewide 60 

Integrated MH/Substance Abuse Services Statewide 7 

Supported Housing Parts of the state 

Consumer-Operated Services Statewide 50 

Functional Family Therapy Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practices Implementation Number of Programs 

Wraparound Statewide 

Peer Support Specialist Statewide 

Dialectical Behavior Therapy Statewide 15 

Motivational Interviewing Statewide 32 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. Improving 

Practices Leadership Teams: System transformation activities that include assuring systems are 

based in recovery training initiatives. 

Funding and Characteristics of State Mental Health Agencies, 2007– Michigan 101 
Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. 

State’s share of the Medicaid match is 43 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has lead responsibility 

Writing waiver SMHA has lead responsibility 

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

SMHA serves as managed care agent SMHA has lead responsibility 

Mental health parity laws: 

The SMHA does not mandate mental health insurance benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in community mental health programs. Local 

providers use a variety of EHR systems.

Funding and Characteristics of State Mental Health Agencies, 2007– Michigan 102 
Funding and Characteristics of State Mental Health Agencies, 2007– Michigan 103 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are six SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer than 

30 days) 

Intermediate inpatient 

(30–90 days) 

Long-Term 

Inpatient (more 

than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes 

The average daily census in FY 2006 for youth was 67 and for adults was 768 receiving state 

psychiatric inpatient care. 

Psychiatric inpatient bed shortages: 

The state is not experiencing a shortage of psychiatric beds. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members; early identification and coordination.
MINNESOTA 2007 

P.O. Box 64981 

Saint Paul, MN 55164-0981

Minnesota is state-supervised, county-administered public 

mental health. Within this system, three agencies/organizations 

are responsible for funding and assuring quality mental health 

services: (1) the state mental health authority (SMHA), part of 

the Minnesota Department of Human Services; (2) the local 

mental health authority (the county board of commissioners and 

its administrative agency, or multicounty mental health 

authority); and (3) American Indian tribal governments. The 

adult Mental Health Division (MHD) is a division within the 

Chemical and Mental Health Services Administration 

(CandMHSA). The CandMHSA also includes the Children’s 

Mental Health Division (CMHD), the Chemical Health 

Division, and State Operated Services Networks. Counties 

receive state grants for adult mental health services and 

"consolidated" grants for other human services (including 

children’s mental health services).

Statistics: 

State Population (2006): 5,167,101 

Number of Persons Served (2007): 85,802 

Utilization Rate for Adults: 16 per 1,000 

Utilization Rate for Children: 19 per 1,000 

 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $669.3 million

Revenue From Medicaid $303.6 million 

Expenditure for Community Mental Health Services (73% of Total 

SMHA Revenues) $490.9 million 

Per Capita State Mental Health Spending $130.6 

Funding and Characteristics of State Mental Health Agencies, 2007– Minnesota 104 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status No responsibility 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services No responsibility

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Shared with another agency 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department

Substance Abuse Agency Same umbrella department 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 11 0 11 

Community Mental Health Providers 0 600 600 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 16 16 

Nursing Homes and Other ICF-MI and SNF 

Providers 1 0 1 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Funding and Characteristics of State Mental Health Agencies, 2007– Minnesota 105 
Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state 26 

Supported Employment Parts of the state 31 

Integrated MH/Substance Abuse Services Parts of the state 55 

Self-Management Statewide 21 

Supported Housing Statewide 20 

Consumer-Operated Services Statewide 16 

Multisystemic Therapy (Conduct Disorder) Parts of the state 21 

Therapeutic Foster Care Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Emerging EBPs and Innovative Practices Availability Number of 

Programs 

Replication of Hawaii data-based systems Parts of state 25 

Shared care/collaboration models (adult and 

children) Dialectical Behavioral Therapy 

(DBT) 

Parts of state 4 

DBT for persons with borderline personality 

disorder Available statewide 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; core competencies, 

training monthly, consultation with national experts. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid Research and Demonstration 

(1115) waiver. State’s share of the Medicaid match is 50 percent.

Funding and Characteristics of State Mental Health Agencies, 2007– Minnesota 106 
The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has joint responsibility with medicaid 

agency 

Writing waiver SMHA has joint responsibility with medicaid 

agency 

Contracting SMHA has joint responsibility with medicaid 

agency 

Monitoring SMHA has joint responsibility with medicaid 

agency 

Evaluating SMHA has joint responsibility with medicaid 

agency 

SMHA serves as managed care agent SMHA has joint responsibility with medicaid 

agency 

Mental health parity laws: 

The state mandates mental health insurance benefits. These benefits include any mental health 

and substance abuse service. The mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections No Yes 

Health No Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice No Yes 

Child Welfare No Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Specific language passed in 2003 prohibits 

relinquishing custody to obtain mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals. The state does not use a 

single EHR system for all community mental health providers. Local providers use a variety of 

EHR systems. 

Funding and Characteristics of State Mental Health Agencies, 2007– Minnesota 107 
State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are 11 state-operated psychiatric hospitals including a forensic hospital. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes 

Forensic Yes Yes 

The average daily census in FY 2006 for youth was 81 and for adults was 340 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

The commitment status of patients in state hospital on the last day of the year shows that 40 

percent were voluntarily admitted while 60 percent were involuntarily civilly committed. 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in general hospital specialty unit psychiatric and state psychiatric hospital beds in the 

last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard to assure the provision of services to meet 

the mental health needs of veterans and National Guard members.

Funding and Characteristics of State Mental Health Agencies, 2007– Minnesota 108 
MISSISSIPPI 2007 

239 North Lamar Street 

Suite 1101 

Jackson, MS 39201

The Mississippi Department of Mental Health is under separate 

governance by the State Board of Mental Health, which oversees 

mental health, mental retardation/developmental disabilities, and 

substance abuse services, as well as limited services for persons with 

Alzheimer’s disease/other dementia.

Statistics: 

State Population (2006): 2,910,540 

Number of Persons Served (2007): 92,003 

Utilization Rate for Adults: 29 per 1,000 

Utilization Rate for Children: 40 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $305.9 million

Revenue From Medicaid $156.9 million 

Expenditure for Community Mental Health Services (44% of Total 

SMHA Revenues) $135.5 million 

Per Capita State Mental Health Spending $105.68 

Workforce development initiatives: 

The SMHA does not have initiatives to improve the quality of the mental health workforce. 

Managed behavioral healthcare: 

State’s share of the Medicaid match is 24 percent. 

Electronic Health Records (EHR): 

The SMHA is in the process of installing an EHR in community mental health programs. The 

SMHA has some EHR components implemented in state hospitals and community mental health 

programs. The state does not use a single EHR system for all community mental health 

providers. Local providers do not use a variety of EHR systems.

Funding and Characteristics of State Mental Health Agencies, 2007– Mississippi 109 
MISSOURI 2007 

1706 East Elm Street 

Jefferson City, MO 65102 

DMH and Network of 

Care

The Department of Mental Health (DMH) is the Missouri agency 

authorized to develop and implement the public mental health 

delivery system. The DMH has three operating divisions: Division 

of Comprehensive Psychiatric Services (CPS), Division of Alcohol 

and Drug Abuse (ADA), and the Division of Mental Retardation 

and Developmental Disabilities (MRDD). Each of the three 

Divisions has its own state advisory structure and target 

populations. There are four regional hospital systems comprised of 

11 CPS inpatient facilities. For the provision of community-based 

services, Missouri’s 114 counties and the City of Street Louis are 

subdivided into 25 mental health service areas, each with an 

Administrative Agent (AA). AAs are community mental health 

centers responsible for the assessment and provision of services to 

persons in their designated area and for providing followup 

services to persons released from state-operated inpatient services.

Statistics: 

State Population (2006): 5,842,713 

Number of Persons Served (2007): 73,808 

Utilization Rate for Adults: 13 per 1,000 

Utilization Rate for Children: 12 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $414.0 million

Revenue From Medicaid $266.2 million 

Expenditure for Community Mental Health Services (51% of Total 

SMHA Revenues) $193.8 million 

Per Capita State Mental Health Spending $71.59 

Funding and Characteristics of State Mental Health Agencies, 2007– Missouri 110 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services Part of the SMHA 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Different state department

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 11 0 11 

Community Mental Health Providers 0 30 30 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation 

Assertive Community Treatment (ACT) Parts of the state 

Supported Employment Parts of the state 

Medication Algorithms (Schizophrenia) Statewide 

Medication Algorithms (Bipolar Disorders) Statewide 

Integrated MH/Substance Abuse Services Parts of the state 

Supported Housing Parts of the state 

Consumer-Operated Services Parts of the state 

Multisystemic Therapy (Conduct Disorder) Parts of the state 

Therapeutic Foster Care Statewide 

Functional Family Therapy Parts of the state 

Funding and Characteristics of State Mental Health Agencies, 2007– Missouri 111 
Emerging evidence-based and innovative practices: 

Evidence-Based Practices 

Pro-Recovery 

Federally Qualified Health Centers (FQHC)/Community Mental Health Centers (CMHC) 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce, such as requesting 

new budget items and making merit system changes for medical staff. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 38 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency 

Writing waiver SMHA jointly responsible with Medicaid agency 

Contracting 

Monitoring SMHA jointly responsible with Medicaid agency 

Evaluating 

SMHA serves as managed care agent SMHA has no responsibility 

Note: Blank space indicates the state did not report data for this category. 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: see block grant. 

Telemedicine: 

The SMHA promotes the use of telemedicine; to be addressed in Transformation Plan. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals and community mental 

health programs. The SMHA is in the process of installing an EHR in community mental health 

programs. The SMHA has some EHR components implemented in community mental health 

programs. The SMHA has implemented all EHR components in community mental health 

programs. The state does not use a single EHR system for all community mental health 

providers. Local providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are 11 SMHA-operated state psychiatric hospitals. 

Funding and Characteristics of State Mental Health Agencies, 2007– Missouri 112 
SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer than 30 

days) 

Long-Term Inpatient (more than 

90 days) 

Children Yes 

Adolescents Yes 

Adults Yes Yes 

Forensic Yes Yes 

The average daily census in FY 2007 for youth was 69 and for adults was 1,303 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

The commitment status of patients in state hospitals on the last day of the year shows that 40 

percent were voluntarily admitted, 21 percent were involuntarily civilly committed, while 39 

percent were involuntarily criminally committed. 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in general hospital specialty unit psychiatric beds in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the Federal Department of Veterans Affairs to assure the provision 

of services to meet the mental health needs of veterans and National Guard members.

Funding and Characteristics of State Mental Health Agencies, 2007– Missouri 113 
MONTANA 2007 

P.O. Box 202905 

Helena, MT 59620

The Montana Department of Public Health and Human Services 

(DPHHS) is the state agency responsible for the public mental 

health system. The adult and children’s systems have separate 

administrative structures within DPHHS. The adult mental health 

system is administered through the Addictive and Mental 

Disorders Division. This division also administers three state-run 

facilities: the Montana State Hospital, the Montana Mental 

Health Nursing Care Center, and the Montana Chemical 

Dependency Center. The Health Resources Division administers 

children’s services through the Children’s Mental Health Bureau. 

In addition, HRD is responsible for Medicaid Primary Care 

services and the Children’s Health Insurance Program (CHIP). 

Medicaid mental health services are provided to adults with 

severe disabling mental illness (SDMI) through a fee-for-service 

system. The state also administers the Mental Health Services 

Plan (MHSP) for adults with SDMI who are not eligible for 

Medicaid and have a family income that does not exceed 150 

percent of the Federal poverty level.

Statistics: 

State Population (2006): 944,632 

Number of Persons Served (2007): 26,248 

Utilization Rate for Adults: 25 per 1,000 

Utilization Rate for Children: 38 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $124.8 million

Revenue From Medicaid $85 million 

Expenditure for CommunityMental Health Services (80% of Total 

SMHA Revenues) $99.4 million 

Per Capita State Mental Health Spending $134.03 

Funding and Characteristics of State Mental Health Agencies, 2007– Montana 114 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Shared with another agency 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department

Substance Abuse Agency Same umbrella department 

State Housing Department Different state department 

State Health Department Same umbrella department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 1 0 1 

General Hospitals With Separate Psychiatric Units 0 4 4 

Nursing Homes and Other ICF-MI and SNF Providers 1 0 1 

Primary mechanism in delivering mental health services: 

SMHA directly funds, but does not operate local community-based programs.

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state   6 

Supported Employment Statewide 

Integrated MH/Substance Abuse Services Parts of the state 

Consumer-Operated Services Pilot program in parts of the state 

Therapeutic Foster Care Parts of the state 12 

Note: Blank space indicates the state did not report data for this category. 

Funding and Characteristics of State Mental Health Agencies, 2007– Montana 115 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce such as salary 

increase for selected professional categories in state-run facilities and pursuit of telepsychiatry 

pool. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 28 percent. 

Mental health parity laws: 

The state mandates mental health insurance benefits. Only benefits for specific mental health 

diagnoses are included: schizophrenia, schizoaffective disorder, bipolar disorder, major 

depression, panic disorder, obsessive compulsive disorder, autism. The mandate includes parity 

with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Corrections Yes Yes 

Custody relinquishment: 

There were no children who had their parents’ custody relinquished in 2007 in order to receive 

mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. Statewide telemedicine/video system used for 

treatment/assessments and for statewide training for providers. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in community mental health programs. The 

SMHA is in the process of installing an EHR in state hospitals. The SMHA has some EHR 

components implemented in state hospitals. The state does not use a single EHR system for all 

community mental health providers. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one SMHA-operated state psychiatric hospital. 

Funding and Characteristics of State Mental Health Agencies, 2007– Montana 116 
Funding and Characteristics of State Mental Health Agencies, 2007– Montana 117 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2007 for adults was 199 receiving state psychiatric inpatient 

care. 

Psychiatric inpatient bed shortages: 

The state has experienced a decline in psychiatric inpatient bed capacity. There have been 

declines in general hospital specialty unit psychiatric beds in the last 5 years. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard to assure the provision of services to meet 

the mental health needs of veterans and National Guard members; participated in Governor’s 

Task Force to identify mental health needs of returning veterans and National Guard personnel. 
NEBRASKA 2007 

P.O. Box 98925 

Lincoln, NE 68509

The Division of Behavioral Health is within the Nebraska Department 

of Health and Human Services. The Division is the chief behavioral 

health authority for the State. The Nebraska Behavioral Health 

Services Act defines the term Behavioral Health Disorder as "mental 

illness or alcoholism, drug abuse, problem gambling, or other 

addictive disorder." The Division’s primary role involves State 

administration of non-Medicaid public behavioral health services. 

The Division contracts with the six Regional Behavioral Health 

Authorities (RBHA) to purchase community mental health and 

substance abuse services using the state and Federal funds. Each 

RBHA is governed by a Regional Governing Board consisting of one 

commissioner from each county assigned to the region. The Division 

is a direct service provider of mental health services through state 

psychiatric hospitals, referred to as Regional Centers. The Gamblers 

Assistance Program (GAP) provides training, education, and 

treatment services in an effort to reduce problem gambling and 

gambling-related addictions in Nebraska. The Division contracts with 

Magellan Behavioral Health for Managed Care Administration 

Service Organization (ASO) Mental Health and Substance Abuse 

(MH/SA) services. The act established the Behavioral Health office of 

Consumer Affairs within the Division. This office helps people who 

have experienced mental illness, substance abuse, and/or problem 

gambling to pursue a journey of recovery that will allow him or her to 

live in the community of his or her choice.

Statistics: 

State Population (2006): 1,768,331 

Number of Persons Served (2007): 37,163 

Utilization Rate for Adults: 25 per 1,000 

Utilization Rate for Children: 9 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $106.1 million

Revenue From Medicaid $9.9 million 

Expenditure for Community Mental Health Services (38% of Total 

SMHA Revenues) $40 million 

Per Capita State Mental Health Spending $60.56 

Funding and Characteristics of State Mental Health Agencies, 2007 – Nebraska 118 
Funding and Characteristics of State Mental Health Agencies, 2007 – Nebraska 119 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency 

State Mental Hospitals Part of SMHA 

Community Mental Health Program Part of SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department 

Substance Abuse Agency Part of SMHA 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. 

Custody relinquishment: 

There were no children who had their parents’ custody relinquished in 2007 in order to receive 

mental health services. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals. The SMHA is in the 

process of installing an HER in state hospitals. The state does not use a single EHR system for 

all community mental health providers. Local providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. 
NEVADA 2007 

4126 Technology Way, 

Second Floor 

Carson City, NV 89706 

http://www.mhds.nv.gov 

The Division of Mental Health and Developmental Services 

(MHDS) is responsible for the operation of state-funded outpatient 

community mental health programs, psychiatric inpatient programs, 

mental health forensic services, and all developmental services 

programs and facilities. The Division is responsible for planning, 

administration, policy setting, monitoring, and budget development 

of all state-funded mental health and developmental services 

programs.

Statistics: 

State Population (2006): 2,495,529 

Number of Persons Served (2007): 28,513 

Utilization Rate for Adults: 13 per 1,000 

Utilization Rate for Children: 7 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $150.5 million

Revenue From Medicaid $22.7 million 

Expenditure for Community Mental Health Services (74% of Total 

SMHA Revenues) $111.3 million 

Per Capita State Mental Health Spending $62.6 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency

Elderly Mental Health Services No responsibility 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Nevada 120 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department  

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Same umbrella department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 2 0 2 

Community Mental Health Providers 19 0 19 

Primary mechanism in delivering mental health services: 

SMHA directly operates community-based programs. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state   3 

Supported Employment Statewide 3 

Medication Algorithms (Schizophrenia) Statewide 3 

Integrated MH/Substance Abuse Services Statewide 3 

Supported Housing Statewide 3 

Consumer-Operated Services Parts of the state 3 

Multisystemic Therapy (Conduct Disorder) Parts of the state 

Therapeutic Foster Care Statewide 3 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation 

Consumer-Assisted Programs Available statewide 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; pay for specific 

disciplines has helped, but created management problems due to salary “compaction.” 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. State’s share of 

the Medicaid match is 47 percent. 

Funding and Characteristics of State Mental Health Agencies, 2007– Nevada 121 
The Medicaid Managed Care population is limited to the two largest counties in Nevada, which 

are Clark (Las Vegas) and Washoe (Reno). TANF clients are mandatory for managed care, 

unless they are SMI or SED, then voluntary. All other Nevada counties are rural and are fee-forservice, regardless of eligibility criteria. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Health Yes Yes 

Housing Yes Yes 

Medicaid Yes Yes 

Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. There were no children who had their parents’ custody 

relinquished in 2007 in order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. 

Electronic Health Records (EHR): 

The SMHA has implemented all EHR components in state hospitals and community mental 

health programs. The state uses a single EHR system for all community mental health providers. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are two SMHA-operated state psychiatric hospitals.

Funding and Characteristics of State Mental Health Agencies, 2007– Nevada 122 
SMHA currently uses its state psychiatric hospital beds for: 

Target Population Acute Inpatient (fewer than 30 days) 

Adults Yes 

The average daily census in FY 2006 for youth was 11 and for adults was 172 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. Nevada continues to experience a 

shortage of psychiatric acute care beds and concurrent overcrowding of emergency rooms, 

particularly in Southern Nevada. 

Funding and Characteristics of State Mental Health Agencies, 2007– Nevada 123 
NEW HAMPSHIRE 2007 

105 Pleasant Street 

Concord, NH 03301 

http://www.dhhs.state.nh.us

The New Hampshire Bureau of Behavioral Health (BBH) aligns 

the overall mission, regional priorities, and funding into a 

comprehensive service delivery system that supports BBH’s 

mission to promote respect, recovery, and full community 

inclusion for people who experience a mental illness, an emotional 

disturbance, and/or a substance abuse or addiction problem. BBH 

approaches this mission by working collaboratively with people 

who receive services and by supporting a network of local services 

that are responsive, effective, and efficient. BBH operates on a 

biennial budget, and the state plan reflects the biennium. New 

Hampshire’s state-funded comprehensive community mental 

health system is based on the values of full community integration, 

consumer choice, family and consumer involvement at all levels, 

and flexible services provided in natural settings

Statistics: 

State Population (2006): 1,314,895 

Number of Persons Served (2007): 46,909 

Utilization Rate for Adults: 35 per 1,000 

Utilization Rate for Children: 39 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $154.9 million

Revenue From Medicaid $91 million 

Expenditure for CommunityMental Health Services (67% of Total 

SMHA Revenues) $103.3 million 

Per Capita State Mental Health Spending $118.6 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Shared with another agency 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services No responsibility 

State Mental Hospitals Shared with another agency 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– New Hampshire 124 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department 

Substance Abuse Agency Same umbrella department 

State Housing Department Different state department 

State Health Department Same umbrella department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

Community Mental Health Providers 11 0 11 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Supported Employment Statewide 10 

Integrated MH/Substance Abuse Services Parts of the state 1 

Self-Management Statewide 10 

Emerging evidence-based and innovative practices: 

Emerging EBPs and Innovative Practices Availability Number of Programs

Trauma-Focused Cognitive Based Therapy Statewide 10 

Intentional Peer Support Statewide 9 

Real Choice Grants 0 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; provision of 

training for the statewide implementation and maintenance of evidence-based practices in the 

CMHCs. 

Managed behavioral healthcare: 

Mental health services are being delivered via managed care. State’s share of the Medicaid 

match is 50 percent. 

Mental health parity laws: 

The state mandates mental health insurance benefits. Only benefits for specific mental health 

diagnoses are included: biologically based mental illness and mandated benefits for other mental 

illness and substance use disorders. The mandate includes parity with physical health service 

benefits. 

Funding and Characteristics of State Mental Health Agencies, 2007– New Hampshire 125 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections No Yes 

Health No Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Child Protection Act New Hampshire RSA 

169C3 NH tries to maintain primary health care provider regardless of whether child is in 

custody. 

Telemedicine: 

The SMHA promotes the use of telemedicine; Genesis CMHC using telemedicine to provide 

psychiatric emergency services to distant locations (rural EDs). 

Electronic Health Records (EHR): 

The SMHA is in the process of installing an EHR in state hospitals and community mental health 

programs. The SMHA has some EHR components implemented in state hospitals and 

community mental health programs. The state does not use a single EHR system for all 

community mental health providers. Local providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is not within the same agency 

responsible for the funding and/or delivery of community-based mental health services. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes 

Adolescents Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 30 and for adults was 177 receiving state 

psychiatric inpatient care. 

Funding and Characteristics of State Mental Health Agencies, 2007– New Hampshire 126 
State psychiatric hospital patient legal status: 

The commitment status of patients in the state hospital on the last day of the year shows that 4 

percent were voluntarily admitted and 96 percent were involuntarily civilly committed. 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in general 

hospital specialty unit psychiatric beds in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard to assure the provision of services to meet 

the mental health needs of veterans and National Guard members; member of the advisory board 

of Disaster Behavioral Health Response Team (DBHRT) under the Office of Homeland Security; 

participate in Operation Welcome Home with the National Guard via contract for services of the 

CMHCs; also some housing for mentally ill veterans.

Funding and Characteristics of State Mental Health Agencies, 2007– New Hampshire 127 
NEW JERSEY 2007 

Capitol Center 

P.O. Box 727 

3rd Floor 

Trenton, NJ 08625 

http://www.njmentalhealthcres.org

The New Jersey Department of Human Services, Division of 

Mental Health Services (DMHS) oversees the state’s public 

system of mental health services, offering a wide range of 

programs and support services. While the Division itself 

directly operates five state psychiatric hospitals, services 

are predominately based in local communities, where 

private agencies provide a variety of program options.

Statistics: 

State Population (2006): 8,696,075 

Number of Persons Served (2007): 334,949 

Utilization Rate for Adults: 45 per 1,000 

Utilization Rate for Children: 201 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $1.2 billion

Revenue From Medicaid $230.2 million 

Expenditure for Community Mental Health Services (63% of Total 

SMHA Revenues) $769.8 million 

Per Capita State Mental Health Spending $139.84 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency 

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– New Jersey 128 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department 

Substance Abuse Agency Same umbrella department 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 5 0 5 

Community Mental Health Providers 0 120 120 

Private Psychiatric Hospitals* NA 6* 6 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

*These are county hospitals ONLY, not private hospitals. 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Statewide 31 

Supported Employment Statewide 22 

Medication Algorithms (Schizophrenia) Parts of the state 5 

Family Psychoeducation 21 

Integrated MH/Substance Abuse Services Pilot program in parts of the state 5 

Self-Management Pilot program in parts of the state 24 

Supported Housing Statewide 42 

Consumer-Operated Services Statewide 27 

Therapeutic Foster Care Statewide 31 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of Programs 

Jail Diversion/Reentry Programs Parts of the state 13 

Funding and Characteristics of State Mental Health Agencies, 2007– New Jersey 129 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. The workforce 

development committee is continuing to provide education and training to staff with the ultimate 

goal of transitioning daily job and interactions with consumers into the wellness and recovery 

model/initiative. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 50 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has lead responsibility

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

Mental health parity laws: 

The state mandates mental health insurance benefits. Only benefits for specific mental health 

diagnoses are included. There are two New Jersey statutes that mandate parity of coverage to 

physical health insurance. One statute was enacted in 1999 and mandates coverage for 

biologically based mental health diagnoses. Under the statute, biologically based mental health 

diagnoses are defined as: “a mental or nervous condition that is caused by a biological disorder 

of the brain and results in a clinically significant or psychological syndrome or patter that 

substantially limits the functioning of the person with the illness, including but not limited to 

schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and 

other psychotic disorders, obsessive-compulsive disorder, panic disorder and pervasive 

developmental disorder or autism.” 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education No Yes 

Funding and Characteristics of State Mental Health Agencies, 2007– New Jersey 130 
Custody relinquishment: 

The state does not have laws designed to mandate that parents must relinquish custody of 

children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order to obtain mental 

health services. There were no children who had their parents’ custody relinquished in 2007 in 

order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. Telepsychiatry is utilized in a few screening 

centers in the southern region and in Somerset and Warren counties in the Northern region of the 

state. DMHS permits the use of telepsychiatry under regulated circumstances. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals. The SMHA has some EHR 

components implemented in state hospitals. The state does not use a single EHR system for all 

community mental health providers. Local providers do not use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are five SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2007 for youth was 39 and adults was 2,274 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds; however, DMHS has planned to expand 

its acute care inpatient short-term care facility beds. 

Funding and Characteristics of State Mental Health Agencies, 2007– New Jersey 131 
Funding and Characteristics of State Mental Health Agencies, 2007– New Jersey 132 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the Federal Department of Veterans Affairs to assure the provision 

of services to meet the mental health needs of veterans and National Guard members. DMHS has 

partnered with the Department of Military Affairs and Veterans Administration (DMAVA) to 

provide reciprocal Web links advertising help lines that offer information, counseling, and 

support services to veterans previously deployed and returning from war. DMHS and DMAVA 

will also be engaging in planning discussions to explore partnership opportunities that will 

increase access to mental health services for veterans. Discussions are scheduled to take place in 

fall 2007. 
NEW MEXICO 2007 

1190 Street Francis Drive 

Santa Fe, NM 87502 

http://www.valueoptions.com

As New Mexico continues its ongoing transformation of the 

behavioral health system, FY 2007 and FY 2008 will continue to 

mark some of the most significant systemic changes to date. 

2004 legislation created the Behavioral Health Purchasing 

Collaborative (the Collaborative) and in 2006 the Behavioral 

Health Planning Council was restructured. This resulted in 

coordinated management of most state and Federal behavioral 

health funding and administration of these funds by a single 

statewide entity. As the single statewide entity contract with 

Value Options, New Mexico began its third contract year in 

July 2007. The state has moved forward with internal 

infrastructure development and critical efforts to rebalance the 

system of care for both children and adults. The most significant 

new developments in New Mexico include the creation of a 

Behavioral Health Strategic Plan setting 10 priorities. This plan 

emphasizes stronger and more central roles for consumers and 

family members in planning, policy development, and oversight. 

Cross-agency teams are key to the state infrastructure for the 

Collaborative. Local Collaboratives in 13 geographic and 2 

Native American areas, as well as the statewide Behavioral 

Health Planning Council, are the critical tools by which the 

state seeks advice from consumers and families. A major 

advancement in both the adult and children’s systems is the 

expanded use of telehealth. Children, their families, and adult 

consumers in the rural and frontier areas of New Mexico are 

increasingly less isolated from the services and supports they 

require due to increased availability of video conferencing for 

reunification, prerelease staffing, case consultations, 

psychological evaluations, and medication management. In 

addition, local collaboratives are using teleconferencing to 

effectively engage people in rural and frontier areas.

Statistics: 

State Population (2006): 1,954,599 

Number of Persons Served (2007): 72,959 

Utilization Rate for Adults: 30 per 1,000 

Utilization Rate for Children: 59 per 1,000 

Funding and Characteristics of State Mental Health Agencies, 2007– New Mexico 133 
Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $46.4 million

Revenue From Medicaid $4.6 million 

Expenditure for Community Mental Health Services (53% of Total 

SMHA Revenues) $21.7 million 

Per Capita State Mental Health Spending $24.23 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency 

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Shared with another agency 

Brain Impaired Services (including Traumatic 

Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain 

Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in 

Prison/Jail Shared with another agency 

Sex Offender Services Shared with another agency 

State Mental Hospitals Shared with another agency 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department 

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 1 1 2 

Community Mental Health Providers 0 23 23 

Private Psychiatric Hospitals NA 3 3 

General Hospitals With Separate Psychiatric Units 0 1 1 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Funding and Characteristics of State Mental Health Agencies, 2007– New Mexico 134 
Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Pilot program in parts of the state 2 

Supported Employment Statewide 1 

Integrated MH/Substance Abuse Services Statewide 4 

Supported Housing Statewide 5 

Consumer-Operated Services Pilot Program 30 

Multisystemic Therapy (Conduct Disorder) Statewide 19 

Therapeutic Foster Care Statewide 15 

Function Family Therapy Statewide 5 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of 

Programs 

Native American Traditional Healing Practices 2 Reservation 

2 Metro 4 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the mental health workforce. The purchasing 

collaborative has assigned responsibility of workforce development to the newly formed New 

Mexico Consortium for Behavioral Health Training and Research (NM CBHTR) to assess the 

severe shortages and to make recommendations. This will be an ongoing initiative. The goals for 

CBHTR are to develop their infrastructure, funding, and advisory groups from academic 

institutions, providers, consumers, and families. They are also developing a statewide training 

and workforce development plan among other specific objectives. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. State’s share of 

the Medicaid match is 25 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system Joint responsibility with Medicaid

Writing waiver SMHA has no responsibility 

Contracting Joint responsibility with Medicaid 

Monitoring Joint responsibility with Medicaid 

Evaluating Joint responsibility with Medicaid 

SMHA serves as managed care agent SMHA has lead responsibility 

Funding and Characteristics of State Mental Health Agencies, 2007– New Mexico 135 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: A parent does not have to relinquish custody in 

order to get services. There were no children who had their parents’ custody relinquished in 2007 

to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. Initiative was established at the University of New 

Mexico and has been expanded statewide. ValueOptions New Mexico has extended funding to a 

number of their contractors to ensure this service. There is a state Medicaid plan to use 

telehealth. The SBIRT Grant has 32 sites that have telemedicine capabilities to do motivational 

interviewing and counseling. 

Electronic Health Records (EHR): 

The SMHA has some EHR components implemented in state hospitals. The state does not use a 

single EHR system for all community mental health providers. Local providers do not use a 

variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is not within the same agency 

responsible for the funding and/or delivery of community-based mental health services. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

The average daily census in FY 2006 for adults was 63 receiving state psychiatric inpatient care. 

The state has not indicated the average daily census in FY 2007 for youth receiving state 

psychiatric inpatient care. 

Funding and Characteristics of State Mental Health Agencies, 2007– New Mexico 136 
State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is not experiencing a shortage of psychiatric beds. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members. There is a working group on behavioral health services to military 

personnel and their families that is reporting to the Governor and conducting a pilot PTSD 

project in one area of the state. The SMHA initiated a program to train and supervise clinicians 

to treat PSTD through the technique of Eye Movement Desensitization or EMDR. 

Funding and Characteristics of State Mental Health Agencies, 2007– New Mexico 137 
NEW YORK 2007 

44 Holland Avenue 

Albany, NY 12229 

http://www.omh.state.ny.us

The Office of Mental Health is responsible for the administration 

of a large state-operated system of state institutions. The Office is 

responsible for the regulation and licensing of all mental health 

facilities and programs in the state other than private practice and 

Federal facilities.

Statistics: 

State Population (2006): 19,306,183 

Number of Persons Served (2007): 615,379 

Utilization Rate for Adults: 32 per 1,000 

Utilization Rate for Children: 30 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $4.0 billion

Revenue From Medicaid $2.1 billion 

Expenditure for Community Mental Health Services (69% of Total 

SMHA Revenues) $2.7 billion 

Per Capita State Mental Health Spending $206.21 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail Part of the SMHA 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Prison part of the SMHA; jails, 

no responsibility 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Different state department 

Substance Abuse Agency Different state department 

State Housing Department Different state department 

State Health Department Different state department 

Funding and Characteristics of State Mental Health Agencies, 2007– New York 138 
The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 27 0 27 

Community Mental Health Providers 160 3,041 3,201 

General Hospitals With Separate Psychiatric Units 0 6 6 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Statewide 76 

Supported Employment Statewide 147 

Medication Algorithms (Schizophrenia) Parts of the state 

Medication Algorithms (Bipolar Disorders) Parts of the state 

Family Psychoeducation Parts of the state 17 

Integrated Mental Health/Substance Abuse 

Services Parts of the state 

Self-Management Parts of the state 

Supported Housing Statewide 421 

Consumer-Operated Services Statewide 

Multisystemic Therapy (Conduct Disorder) Pilot program 

Therapeutic Foster Care Parts of the state 

Functional Family Therapy Parts of the state 0 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence based and innovative practices: 

Evidence-Based Practices Implementation Number of 

Programs 

Single Point of Access Available statewide 65 

Clinic Plus Available statewide 300 

PTSD Available statewide 

Peer Support/Self-Help Available statewide 

DBT Available in parts of state 

“Gatekeeper” At-Risk Identification Available in parts of state 3 

Mental Health/Physical Health Integration Available in parts of state 7 

Note: Blank space indicates the state did not report data for this category. 

Funding and Characteristics of State Mental Health Agencies, 2007– New York 139 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; preventing and 

managing crisis situations, safety training for mental health workers, safe and therapeutic 

environment, and other programs tailored to policy and JCHO standards. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 35 percent. 

Mental Health Parity Laws: 

The state mandates mental health insurance benefits. These benefits include any mental health 

service, but not substance abuse services. Other small employers have limited mandates. The 

mandate includes parity with physical health service benefits. 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Available array of residential services based on 

need, not custody. There were no children who had their parents’ custody relinquished in 2007 in 

order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine; Grand Rounds satellite training, NYPI science to 

service consulting, rural counties consulting/training for primary doctors. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in community mental health programs. The 

SMHA is in the process of installing an EHR in community mental health programs. The SMHA 

has some EHR components implemented in community mental health programs. The SMHA has 

implemented all EHR components in state hospitals and community mental health programs. The 

state does not use a single EHR system for all community mental health providers. Local 

providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are 27 SMHA-operated state psychiatric hospitals. 

Funding and Characteristics of State Mental Health Agencies, 2007– New York 140 
SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes 

Adolescents Yes Yes 

Adults Yes Yes 

Elderly Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2007 for youth was 500 and for adults was 4,568 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

There have been declines in general hospital specialty unit psychiatric beds in the last year. The 

state is not experiencing a shortage of psychiatric beds. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members. Ongoing work with VA on mental health needs of returning veterans 

and families; recent work with National Guard.

Funding and Characteristics of State Mental Health Agencies, 2007– New York 141 
NORTH CAROLINA 2007 

Albermarle Building, Room 1149 

Raleigh, NC 27606 

http://www.dhhs.state.nc.us/mhddsas/ 

The Division of Mental Health, Developmental 

Disabilities, and Substance Abuse Services (MHDDSAS) 

is the state agency responsible for mental health 

services. The Division’s state facilities consist of four 

regional psychiatric hospitals, four developmental 

disabilities centers, three substance abuse treatment 

centers, a specialty nursing facility for mentally ill 

consumers, a specialty nursing facility for consumers 

with developmental disabilities, and two residential 

facilities for children with serious emotional 

disturbances.

Statistics: 

State Population (2006): 8,856,505 

Number of Persons Served (2007): 246,609 

Utilization Rate for Adults: 27 per 1,000 

Utilization Rate for Children: 31 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency Controlled Revenues $1.0 billion

Revenue From Medicaid $617.1 million 

Expenditure for CommunityMental Health Services (73% of Total 

SMHA Revenues) $749.0 million 

Per Capita State Mental Health Spending $119.82 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Part of the SMHA 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– North Carolina 142 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Same umbrella department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 4 0 4 

Community Mental Health Providers 0 26 26 

Nursing Homes and Other ICF-MI and SNF Providers 1 0 1 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Statewide 47 

Supported Employment Parts of the state 40 

Family Psychoeducation Parts of the state 5 

Integrated MH/Substance Abuse Services Parts of the state 10 

Self-Management Parts of the state 9 

Supported Housing Statewide 26 

Consumer-Operated Services Parts of the state 11 

Multisystemic Therapy (Conduct Disorder) Parts of the state 6 

Therapeutic Foster Care Statewide 1 

Functional Family Therapy Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of Programs 

Consumer-Run Services Parts of the state 

Consumer-Run Recovery Parts of the state 

Geriatric Specialty Teams Parts of the state 20 

Note: Blank space indicates the state did not report data for this category. 

Funding and Characteristics of State Mental Health Agencies, 2007– North Carolina 143 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; joint workforce 

development initiative between Division and the NC Commission for MH/DD/SAS to identify 

and recommend strategies that the Division should undertake over the next several years to retain 

current staff and recruit new workers into this field (due December 2007). 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care in 1 of 24 

catchment areas. These behavioral health services are administered through a Medicaid 1915(b) 

waiver. State’s share of the Medicaid match is 36 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency 

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA jointly responsible with Medicaid agency 

Evaluating SMHA jointly responsible with Medicaid agency 

SMHA serves as managed care agent SMHA has no responsibility 

Mental health parity laws: 

The state mandates mental health insurance benefits. Legislation was signed 7/27/07 and will 

become effective 7/1/08; also provides minimum required benefits of 30 combined inpatient and 

outpatient days per year and 30 office visits per year for the following illnesses: bipolar disorder, 

major depressive disorder, obsessive compulsive disorder, paranoid and other psychotic 

disorders, schizoaffective disorder, schizophrenia, posttraumatic stress disorder, anorexia 

nervosa and bulimia. The mandate includes parity with physical health service benefits.

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Funding and Characteristics of State Mental Health Agencies, 2007– North Carolina 144 
Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: (1) Services and supports are broad and target 

populations for these services including those children at risk of out of home placement or DDS 

custody; (2) Coordination of policy and practice with child welfare occurs; and (3) state CTSP 

(Comprehensive Treatment Services Program) special provision funding. 

Telemedicine: 

The SMHA promotes the use of telemedicine; has started to investigate ways to expand this 

capacity; exploring a partnership with East Carolina University and considering exploring 

funding sources; drafted a statement of need and will continue to develop same. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in community mental health programs. The 

SMHA is in the process of installing an EHR in state hospitals. Local providers use a variety of 

EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are four SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 160 and for adults was 977 receiving state 

psychiatric inpatient care. 

Funding and Characteristics of State Mental Health Agencies, 2007– North Carolina 145 
State psychiatric hospital patient legal status: 

The commitment status of patients in state hospitals on the last day of the year shows that 4 

percent were voluntarily admitted, 95 percent were involuntarily civilly committed, and 2 

percent were involuntarily criminally committed. 

Note: Percentage may not total 100 because of rounding. 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in state 

psychiatric hospital beds in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Departments of Veterans 

Affairs and Defense to assure the provision of services to meet the mental health needs of 

veterans and National Guard members. There is a link on the Division website to the Web page 

for the Governor’s Focus on Returning Combat Veterans and Their Families 

(http://www.governorsinstitute.org).

Funding and Characteristics of State Mental Health Agencies, 2007– North Carolina 146 
NORTH DAKOTA 2007 

ND DHS MHSAS 

1237 W. Divide Ave 

Suite 1C 

Bismarck, ND 58501-1208 

http://www.nd.gov/dhs 

The Division of Mental Health and Substance Abuse Services is 

a part of the Program and Policy component of the Department 

of Human Services. It works closely with other public agencies 

(such as the Department of Public Instruction, the Department 

of Health, and the Department of Corrections and 

Rehabilitation), as well as a myriad of private and not-forprofit human service agencies to ensure quality and effective 

mental health services are provided throughout the state.

Statistics: 

State Population (2006): 635,687 

Number of Persons Served (2007): 15,493 

Utilization Rate for Adults: 25 per 1,000 

Utilization Rate for Children: 22 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $46.8 million

Revenue From Medicaid $10.2 million 

Expenditure for Community Mental Health Services (60% of Total 

SMHA Revenues) $28 million 

Per Capita State Mental Health Spending $74.39 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency 

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Shared with another agency 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status No responsibility 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services Shared with another agency 

State Mental Hospitals Shared with another agency 

Community Mental Health Program Shared with another agency 

Funding and Characteristics of State Mental Health Agencies, 2007– North Dakota 147 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department as the SMHA

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 0 0 0 

Community Mental Health Providers 0 0 0 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Integrated MH/Substance Abuse Services Pilot program in parts of the state 1 

Therapeutic Foster Care Statewide 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of Programs 

Wraparound Statewide 1 

Mental Health Recovery Statewide 8 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; coordination and 

collaboration with WICHE to identify gaps and strengths of workforce. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 33 percent. 

Funding and Characteristics of State Mental Health Agencies, 2007– North Dakota 148 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Health No Yes 

Housing Yes Yes 

Education No Yes 

Juvenile Justice No Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: state statute and program policies. 

Telemedicine: 

The SMHA promotes the use of telemedicine; telemedicine workgroup looking at feasibility of 

implementing telemedicine. 

Electronic Health Records (EHR): 

The SMHA has some EHR components implemented in state hospitals and community mental 

health programs. The state uses a single EHR system for all community mental health providers. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are no SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for adults was 257 receiving state psychiatric inpatient 

care.

Funding and Characteristics of State Mental Health Agencies, 2007– North Dakota 149 
State psychiatric hospital patient legal status: 

The commitment status of patients in state hospital on the last day of the year shows that 3 

percent were voluntarily admitted, 42 percent were involuntarily civilly committed, while 55 

percent were involuntarily criminally committed. 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard to assure the provision of services to meet 

the mental health needs of veterans and National Guard members; discussions to ensure 

awareness of potential increase in veterans presenting with psychological issues.

Funding and Characteristics of State Mental Health Agencies, 2007– North Dakota 150 
OHIO 2007 

30 E. Broad Street 

Suite 800 

Columbus, OH 43215 

http://www.networkofcare.org 

The Ohio Department of Mental Health (ODMH) contracts with 

50 county and multicounty mental health boards that plan, 

develop, fund, manage, and evaluate mental health services. Of 

these boards, 46 also administer substance abuse services. Four 

board areas have separate boards for drug and alcohol services 

that contract separately with the Ohio Department of Alcohol 

Services. The boards are supported by Federal, state, and local 

funds and are responsible for ensuring that alcohol, drug 

addiction, and/or mental health services are available to those 

who need them.

Statistics: 

State Population (2006): 11,478,006 

Number of Persons Served (2007): 309,594 

Utilization Rate for Adults: 23 per 1,000 

Utilization Rate for Children: 38 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY2005) Dollars 

Total Mental Health Agency-Controlled Revenues $757.7 million

Revenue From Medicaid $329 million 

Expenditure for Community Mental Health Services (70% of Total 

SMHA Revenues) $531.5 million 

Per Capita State Mental Health Spending $66.1 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Shared with another agency 

Funding and Characteristics of State Mental Health Agencies, 2007– Ohio 151 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Different state department 

Substance Abuse Agency Different state department 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State psychiatric hospitals 5 0 5 

Community Mental Health Providers 27 365 392 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state   29 

Supported Employment Parts of the state 10 

Medication Algorithms (Schizophrenia) Parts of the state 

Medication Algorithms (Bipolar Disorders) Parts of the state 

Family Psychoeducation Parts of the state 6 

Integrated MH/Substance Abuse Services Parts of the state 43 

Self-Management Pilot program 4 

Supported Housing Parts of the state 50 

Consumer-Operated Services Parts of the state 68 

Multisystemic Therapy (Conduct Disorder) Parts of the state 17 

Therapeutic Foster Care Parts of the state 

Functional Family Therapy Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Emerging EBPs and Innovative Practices Availability Number of 

Programs 

Intensive Home Base Treatment Statewide 45 

Integrated Services for MI/MRDD Parts of state 46 

Sequential Intercept Model/CIT Crisis Intervention Statewide 49 

Wellness Management and Recovery Parts of state 10 

Funding and Characteristics of State Mental Health Agencies, 2007– Ohio 152 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. These include 31 

residency and traineeship grants to college and university departments of psychiatry, psychology, 

nursing, social work, as well as Health Professional Shortage Area (HPSA) activities. 

Additionally, eight Coordinating Centers of Excellence promote evidence-based practices 

through in-service training, consultation, and fidelity assessment. A contract with NetSmart 

University will support Web-based learning. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. 

Mental health parity laws: 

The state mandates mental health insurance benefits. Only benefits for specific mental health 

diagnoses are included: schizophrenia, schizoaffective disorder, major depressive disorder, 

bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, and 

panic disorder. The mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes No 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Former governor ordered an action plan to 

eliminate custody relinquishment as a requirement for mental health care. 

Telemedicine: 

The SMHA facilitates the use of telemedicine by implementing new certification rules in 2007, 

which increased the regulatory burden for providers. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in community mental health programs. The 

SMHA is in the process of installing an EHR in state hospitals. The SMHA has some EHR 

components implemented in state hospitals. The state does not use a single EHR system for all 

community mental health providers. Local providers use a variety of EHR systems. 

Funding and Characteristics of State Mental Health Agencies, 2007– Ohio 153 
State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are five SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2007 for youth was 25 and for adults was 1,022 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

After declining from 1995 to 2005, Ohio’s state hospital bed capacity has remained unchanged 

from 2005 to 2007. 

Services for Armed Forces veterans and National Guard members: 

In collaboration with the National Guard, the SMHA is working to assure the provision of 

services to meet the mental health needs of veterans and National Guard members; OhioCares 

Initiative; returning Home/Ohio Network of Care website shared training conferences specific to 

needs of returning vets.

Funding and Characteristics of State Mental Health Agencies, 2007– Ohio 154 
OKLAHOMA 2007 

1200 NE 13th Street 

Oklahoma City, OK 73117 

http://www.odmhsas.org 

ODMHSAS: A publicly supported community mental health 

center is located within each of 17 mental health service areas in 

Oklahoma. Most have satellite offices or other specialized 

programs within their service areas. These centers provide 

emergency intervention, assessment, counseling, psychosocial 

rehabilitation, case management, and community support 

services designed to assist adult mental health clients in living as 

independently as possible and to provide therapeutic services for 

children who are demonstrating symptoms of emotional 

disturbance. For clients who need inpatient treatment, the 

Department operates a psychiatric hospital for adults and a 

facility for children under the age of 18 years. Funding is also 

provided to support inpatient services through a network of 

community-based hospitals. There is also a specialty center 

devoted to forensic services. Additionally, the Department 

provides funding for social and recreational services for 

individuals with mental illness who live in residential care 

facilities, as well as support for certain other community-based 

services such as assistance for people who are homeless and 

have a mental illness.

Statistics: 

State Population (2006): 3,579,212 

Number of Persons Served (2007): 44,002 

Utilization Rate for Adults: 14 per 1,000 

Utilization Rate for Children: 6 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY2005) Dollars 

Total Mental Health Agency-Controlled Revenues $157.3 million

Revenue From Medicaid $19.6 million 

Expenditure for Community Mental Health Services (65% of Total 

SMHA Revenues) $101.9 million 

Per Capita State Mental Health Spending $44.67 

Funding and Characteristics of State Mental Health Agencies, 2007– Oklahoma 155 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Different state department

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State psychiatric hospitals 4 0 4 

Community Mental Health Providers 7 10 17 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state 14 

Integrated MH/Substance Abuse Services Statewide 

Supported Housing Parts of the state 16 

Functional Family Therapy Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Funding and Characteristics of State Mental Health Agencies, 2007– Oklahoma 156 
Emerging evidence-based and innovative practices: 

Emerging EBPs and Innovative Practices Availability 

Systems of Care/Wraparound Available in parts of state 

Psychosocial Rehabilitation Available statewide 

Strengths Based Case Management Available statewide 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. Nurse leadership 

initiatives; training specifically for nurses; children’s workforce development; annual 

conferences/special seminar; cross-training for trauma-informed services; integrated (MH/SA) 

services initiatives. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 31 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system No responsibility

Writing waiver No responsibility 

Contracting No responsibility 

Monitoring No responsibility 

Evaluating No responsibility 

SMHA serves as managed care agent No responsibility 

Mental health parity laws: 

The state mandates mental health insurance benefits. Only benefits for specific mental health 

diagnoses are included. The following diagnoses are included: severe mental illness. The 

mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Funding and Characteristics of State Mental Health Agencies, 2007– Oklahoma 157 
Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine; using telemedicine between selected sites to 

facilitate clinical consultation and linkage with court proceedings. ODMHSAS is working with 

providers and consumers through its IT Steering Committee and Transformation Grant to 

identify areas of need and support deployment of equipment to support telemedicine. Department 

and TSIG staff have also met with state university telemedicine project staff to discuss 

collaborating to expand and extend services in rural areas of the state where child and adult 

psychiatrists are desperately needed. 

Electronic Health Records (EHR): 

The SMHA is in the process of installing an EHR in state hospitals and community mental health 

programs. Local providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are four SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 39 and for adults was 315 receiving state 

psychiatric inpatient care. 

Funding and Characteristics of State Mental Health Agencies, 2007– Oklahoma 158 
State psychiatric hospital patient legal status: 

Note: Percentage may not total 100 because of rounding. 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in general 

hospital specialty unit psychiatric, state psychiatric hospital and private psychiatric hospital beds 

in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members; formed statewide workgroup to respond to needs of returning 

veterans. Initiatives include providing mental health and substance abuse education at pre- and 

post-deployment briefings for military members and their families, including a youth initiative; 

statewide resource directory; legislation and funding; public relations and antistigma and peer 

support groups.

Funding and Characteristics of State Mental Health Agencies, 2007– Oklahoma 159 
Oregon 2007 

500 Summer St NE 

Salem, OR 97301 

http://www.oregon.gov

The Oregon Addictions and Mental Health Division (AMH) is 

located within the Department of Human Services (DHS). DHS is 

made up of the following program areas: Children, Adults and 

Families; Seniors and People with Disabilities; AMH, the Office 

of Medical Assistance Programs (State Medicaid Agency) and 

public health related offices. State general funds for 

nonresidential services are allocated to counties using a "block 

grant" approach. AMH currently contracts with 31 counties or 

consortium of counties, one community mental health program 

and one tribe. Capitated mental health services for persons who 

are Medicaid-eligible are administered through contracts 

between AMH and Managed Care Organizations. All other noncapitated services are administered through contracts to the 

counties and direct contracts to service providers for community 

hospitals for acute psychiatric care and a small number of 

residential programs.

Statistics: 

State Population (2006): 3,700,758 

Number of Persons Served (2007): 109,758 

Utilization Rate for Adults: 26 per 1,000 

Utilization Rate for Children: 43 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenues $434.6 million

Revenue From Medicaid $299.3 million 

Expenditure for CommunityMental Health Services (73% of Total 

SMHA Revenues) $318.4 million 

Per Capita State Mental Health Spending $119.48 

Funding and Characteristics of State Mental Health Agencies, 2007– Oregon 160 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail Part of the SMHA 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department 

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Same umbrella department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 2 0 2 

Community Mental Health Providers 0 114 114 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 13 13 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Funding and Characteristics of State Mental Health Agencies, 2007– Oregon 161 
Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state 19 

Supported Employment Parts of the state 30 

Medication Algorithms (Schizophrenia) Parts of the state 55 

Family Psychoeducation Parts of the state 28 

Integrated MH/Substance Abuse Services Parts of the state 84 

Self-Management Parts of the state 11 

Supported Housing Parts of the state 19 

Consumer-Operated Services Parts of the state 13 

Multisystemic Therapy (Conduct Disorder) Parts of the state 11 

Therapeutic Foster Care Parts of the state 8 

Functional Family Therapy Parts of the state 14 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of 

Programs 

Parent/Child Interactive Therapy Parts of the state 1 

Supported Education Parts of the state 

Gatekeeping/Multidisciplinary Team Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the mental health workforce. Workforce 

development initiative is Psychiatric Nurse Workforce Development Team. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid Research and Demonstration 

(1115) waiver. State’s share of the Medicaid match is 38 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has lead responsibility

Writing waiver SMHA jointly responsible with Medicaid agency 

Contracting SMHA jointly responsible with Medicaid agency 

Monitoring SMHA jointly responsible with Medicaid agency 

Evaluating SMHA jointly responsible with Medicaid agency 

SMHA serves as managed care agent SMHA has no responsibility 

Mental health parity laws: 

The state mandates health insurance benefits. These benefits include any mental health and 

substance abuse service. The mandate includes parity with physical health service benefits. 

Funding and Characteristics of State Mental Health Agencies, 2007– Oregon 162 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health No Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Law allows voluntary placement by parent in 

agreement with Child Welfare. 

Telemedicine: 

The SMHA promotes the use of telemedicine for youth and adults in rural areas. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals and community mental 

health programs. The state does not use a single EHR system for all community mental health 

providers. Local providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are two SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes 

Elderly Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 15 and for adults was 718 receiving state 

psychiatric inpatient care. 

Funding and Characteristics of State Mental Health Agencies, 2007– Oregon 163 
State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in state 

psychiatric hospital beds in the last year.

Funding and Characteristics of State Mental Health Agencies, 2007– Oregon 164 
PENNSYLVANIA 2007 

Office of Mental Health and 

Substance Abuse Services 

PA Department of Public 

Welfare 

PO Box 2675 

Admin Building 

DGS Complex Annex 

Harrisburg, Pennsylvania 

17105-2675

Office of Mental Health and Substance Abuse Services (OMHSAS) 

in the Department of Public Welfare has primary responsibility 

for the planning, policy, program development, and financial 

oversight of the behavioral health service system in the 

Commonwealth, which includes mental health treatment services 

and supports, as well as designated substance abuse services. The 

primary objective of these services is to support individual 

movement toward recovery. OMHSAS is the Medicaid State 

Mental Health Authority for behavioral health services, and the 

Office of Medical Assistance Programs (OMAP) manages 

physical health Medicaid. OMHSAS is the state agency 

responsible for substance abuse services for Medicaid recipients, 

while the Department of Health manages the non-Medicaid 

substance abuse services.

Statistics: 

State Population (2006): 12,440,621 

Number of Persons Served (2007): 299,037 

Utilization Rate for Adults: 21 per 1,000 

Utilization Rate for Children: 33.0 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $2.5 billion

Revenue From Medicaid $710.1 million 

Expenditures for Community Mental Health Services (80% of Total 

Mental Health Agency Revenues) $2 billion 

Per Capita State Mental Health Expenditures $204.92 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Part of the SMHA 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail Part of the SMHA 

Sex Offender Services Part of the SMHA 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Pennsylvania 165 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Part of SMHA

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 8 0 8 

Community Mental Health Providers 0 1300 1300 

Private Psychiatric Hospitals NA 31 31 

General Hospitals With Separate Psychiatric Units 0 104 104 

Nursing Homes and Other ICF-MI and SNF Providers 1 0 1 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state 42 

Supported Employment Parts of the state 

Medication Algorithms (Schizophrenia) Parts of the state 7 

Family Psychoeducation Parts of the state 

Integrated MH/Substance Abuse Services Parts of the state 

Self-Management Parts of the state 

Supported Housing Parts of the state 

Consumer-Operated Services Parts of the state 

Multisystemic Therapy (Conduct Disorder) Parts of the state 10 

Therapeutic Foster Care 1 

Functional Family Therapy Parts of the state 8 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of Programs 

Fair Weather Lodge Available in parts of state 19 

Compeer Available in parts of state 13 

Consumer-Run Drop-In Centers Available in parts of state 25 

Funding and Characteristics of State Mental Health Agencies, 2007– Pennsylvania 166 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. The state funds 

three universities and a child and family institute that provides free/low cost array of training to 

all staff within the state. For several years, the state has provided funds to counties for 

recruitment/retention efforts for direct care staff. 

Managed behavioral healthcare: 

Mental health and substance abuse services for all categories of assistance are being delivered 

statewide via managed care. These behavioral health services are administered through a 

Medicaid 1915(b) waiver. State’s share of the Medicaid match is 100 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits 

Task Responsibility 

Designing the mental health benefit system SMHA has lead responsibility

Writing waiver SMHA jointly responsible with Medicaid agency 

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has lead responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Mental health parity laws: 

The state mandates mental health insurance benefits. 

Only benefits for specific mental health diagnoses are included. 

The mandate does not include parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Eligibility requirements for medical assistance 

enable children to receive needed services without parents giving up custody. 

Funding and Characteristics of State Mental Health Agencies, 2007– Pennsylvania 167 
Telemedicine: 

The SMHA promotes the use of telemedicine. There are several pilot projects that provide 

mostly child psychiatric consultations and medication management. Telepsychiatry links include 

schools (nursing office), mental health clinics, and hospitals. One county contracted for afterhour, weekend, and holiday psychiatric consultation to its hospital emergency room. There is a 

proposed initiative from the Office of Medical Assistance Programs to use telemedicine to 

provide consultation to rural primary care. Other identified areas of need include high-risk 

pregnancies and individuals receiving three or more psychiatric medications. Pilots are 

developed by the managed care vendor. 

Electronic Health Records (EHR): 

The state does not use a single EHR system for all community mental health providers. Local 

providers do not use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are seven SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth (18–20) was 19 and for adults was 2,136 

receiving state psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Note: Percentage may not total 100 because of rounding. 

Psychiatric inpatient bed shortages: 

There have been declines in state psychiatric hospital and private psychiatric hospital beds in the 

last year. The state is not experiencing a shortage of psychiatric beds. 

Funding and Characteristics of State Mental Health Agencies, 2007– Pennsylvania 168 
Funding and Characteristics of State Mental Health Agencies, 2007– Pennsylvania 169 

Services for Armed Forces veterans and National Guard members: 

Since 2005, the SMHA has helped organize and cochair the PA CARES task force. The task 

force is a collaborative effort of over 20 organizations including the Department of Public 

Welfare, Department of Health, Pennsylvania Department of Military and Veterans Affairs, 

county mental health authorities, Pennsylvania colleges and universities, Vocational 

Rehabilitation, Association for the Blind, clergy, and numerous other organizations in addition to 

veterans themselves. PA CARES has sponsored or delivered over 30 events aimed at program 

development, training, education, and public awareness. Members of the Task Force identify 

resources for mental health, health, drug and alcohol treatment, education, vocational and other 

resources and work to link those resources with the PA Guardsmen and other PA military.
RHODE ISLAND 2007 

14 Harrington Road 

Cranston, RI 02920 

http://www.mhrh.ri.gov 

The Rhode Island Department of Mental Health, Retardation and 

Hospitals (MHRH) serves hospital patients with chronic, long-term 

debilitating diseases and medical conditions who generally are 

uninsured or underinsured; persons with serious and persistent mental 

illness, emotional difficulty and psychological disorders; people with 

developmental disabilities that are attributable to a cognitive or 

physical impairment, or a combination of cognitive and physical 

impairments; and persons with a problem of substance abuse that is 

chronic, progressive, and relapsing and results in physical and 

psychological dependence on chemical substances. The Rhode Island 

Department of Children, Youth and Families (DCYF) plans, develops, 

and evaluates a comprehensive and integrated statewide program of 

services designed to ensure the opportunity for children.

Statistics: 

State Population (2006): 1,067,610 

Number of Persons Served (2007): 26,886 

Utilization Rate for Adults: 24 per 1,000 

Utilization Rate for Children: 30 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $102.4 million

Revenue From Medicaid $86.3 million 

Expenditures for Community Mental Health Services (73% of Total 

Mental Health Agency Revenues) $74.4 million 

Per Capita State Mental Health Expenditures $95.55 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services No responsibility

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services No responsibility 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Rhode Island 170 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department 

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Same umbrella department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

Community Mental Health Providers 0 10 10 

General Hospitals With Separate Psychiatric Units 1 0 1 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Statewide 14 

Supported Employment Statewide 8 

Family Psychoeducation 1 

Integrated MH/Substance Abuse Services Statewide 

Supported Housing Parts of the state 

Consumer-Operated Services Parts of the state 

Multisystemic Therapy (Conduct Disorder) 7 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the mental health workforce; does not 

provide direct service, but monitors it; and in the process, provides technical assistance to direct 

service provides and train supervisors regarding recovery-oriented treatment planning and 

integrated assessments of mental health provides. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid Research and Demonstration 

(1115) waiver. State’s share of the Medicaid match is 45 percent. 

Funding and Characteristics of State Mental Health Agencies, 2007– Rhode Island 171 
The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has no responsibility 

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA has no responsibility 

Evaluating SMHA jointly responsible with Medicaid agency 

SMHA serves as managed care agent SMHA has no responsibility 

Mental health parity laws: 

The State mandates mental health insurance benefits. These benefits include any mental health 

and substance abuse service. The following diagnoses are included: all mental illnesses and 

substance abuse disorders. The mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes 

Child Welfare Yes Yes 

Note: Blank space indicates the state did not report data for this category. 

Custody relinquishment: 

There were no children who had their parents’ custody relinquished in 2007 in order to receive 

mental health services. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals. The SMHA is in the 

process of installing an EHR in community mental health programs. The SMHA has some EHR 

components implemented in community mental health programs. The state does not use a single 

EHR system for all community mental health providers. Local providers use a variety of EHR 

systems.

Funding and Characteristics of State Mental Health Agencies, 2007– Rhode Island 172 
Funding and Characteristics of State Mental Health Agencies, 2007– Rhode Island 173 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is not within the same agency 

responsible for the funding and/or delivery of community-based mental health services. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes 

Elderly Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 1 and for adults was 148 receiving state 

psychiatric inpatient care. 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in state 

psychiatric hospital beds in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members. Volunteers from local CMHCs and EAPs meet and speak with 

families as required.
SOUTH CAROLINA 2007 

http://www.scdmh.org

The South Carolina Department of Mental Health (DMH) 

provides assessment, diagnosis, and treatment to its priority 

populations through a network of 17 community mental health 

centers (CMHCs) and 3 specialized inpatient facilities. The 17 

CMHCs provide services within their respective counties and 

operate within the policies and guidelines set by DMH. The 

catchment areas covered by each of the 17 CMHCs range from 

part of a county to 7 counties.

Statistics: 

State Population (2006): 4,321,249 

Number of Persons Served (2007): 88,331 

Utilization Rate for Adults: 18 per 1,000 

Utilization Rate for Children: 30 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $285.2 million 

Revenue From Medicaid $155.4 million 

Expenditures for Community Mental Health Services (66% of Total 

Mental Health Agency Revenues) $187.7 million 

Per Capita State Mental Health Expenditures $67.70 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency 

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Part of SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– South Carolina 174 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Different state department 

Substance Abuse Agency Different state department 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 3 0 3 

Community Mental Health Providers 17 0 17 

Nursing Homes and Other ICF-MI and SNF Providers 1 2 3 

Primary mechanism in delivering mental health services: 

SMHA directly operates local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state 3 

Supported Employment Statewide 10 

Medication Algorithms (Schizophrenia) Pilot program 

Supported Housing Statewide 0 

Multisystemic Therapy (Conduct Disorder) Parts of the state 6 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of 

Programs 

Juvenile Justice Diversion Parts of state 

Trauma Screening and TF-CBT Parts of state 10 

School-Base MH Services Statewide 500 

Trauma Screening and TF-CBT Parts of state 

Peer Support Services Parts of state 11 

MH Courts and/or Jail Diversion Parts of state 

Family Education Parts of state 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. Leadership 

development; mentoring program (fourth year). Education, training, and research develop and 

promote numerous opportunities to improve skills of work force. 

Funding and Characteristics of State Mental Health Agencies, 2007– South Carolina 175 
Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. State’s share 

of the Medicaid match is 30 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has no responsibility 

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA has no responsibility 

Evaluating SMHA has no responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Mental health parity laws: 

The State mandates mental health insurance benefits. These benefits include any mental health 

and substance abuse service. The mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes No 

Health Yes No 

Housing Yes No 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: State law provides DSS may provide child 

protective services to children and families of children who are in custody of state. SMHA does 

not precondition services on custody relinquishment. Clients without Medicaid or other 

insurance may find specific services (private residential care) difficult to access. 

Telemedicine: 

The SMHA promotes the use of telemedicine. In application process; collaborating with South 

Carolina Hospital Association. If approved will contact South Carolina hospital emergency 

departments to DMH psychiatric staff 24 hours per day, 7 days per week. 

Funding and Characteristics of State Mental Health Agencies, 2007– South Carolina 176 
Electronic Health Records (EHR): 

The SMHA is in the process of installing an EHR in community mental health programs. The 

SMHA has some EHR components implemented in state hospitals and community mental health 

programs. The state uses a single EHR system for all community mental health providers. Local 

providers do not use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are three SMHA-operated state psychiatric hospitals. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 37 and for adults was 604 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in general 

hospital specialty unit psychiatric beds in the last year.

Funding and Characteristics of State Mental Health Agencies, 2007– South Carolina 177 
SOUTH DAKOTA 2007 

E. Hwy 34 

Hillsview Plaza 

c/o 500 E. Capitol 

Pierre, SD 57501

The Division of Mental Health’s mission is to ensure children and 

adults with mental health disorders in communities have the 

opportunity to choose and receive effective services needed to 

promote resiliency and recovery. In carrying out this mission, the 

Division of Mental Health provides a range of services through 

purchase of service agreements with 11 private, nonprofit 

communities mental health centers (CMHCs). The principal 

responsibilities of the Division of Mental Health are to establish 

policy, develop and administer the implementation of the Community 

Mental Health Services Block Grant, determine and establish 

reasonable standards and requirements for the locally operated 

community mental health centers, and enter into purchase of services 

agreements for assisting in the operation and programs of the local 

mental health centers. The Division of Mental Health also has the 

responsibility for the delivery of mental health services within the 

state’s adult and juvenile correctional facilities.

Statistics: 

State Population (2006): 781,919 

Number of Persons Served (2007): 11,918 

Utilization Rate for Adults: 12 per 1,000 

Utilization Rate for Children: 24 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $55.2 million 

Revenue From Medicaid $19.2 million 

Expenditures for Community Mental Health Services (37% of Total 

Mental Health Agency Revenues) $20.2 million 

Per Capita State Mental Health Expenditures $71.38 

Funding and Characteristics of State Mental Health Agencies, 2007– South Dakota 178 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services No responsibility 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status No responsibility 

Services to Persons With Mental Illness in Prison/Jail Part of the SMHA 

Sex Offender Services No responsibility 

State Mental Hospitals No responsibility 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Different state department 

Substance Abuse Agency Same umbrella department 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 0 0 0 

Community Mental Health Providers 0 11 11 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state 4 

Medication Algorithms (Schizophrenia) Parts of the state 

Medication Algorithms (Bipolar Disorders) Parts of the state 

Integrated MH/Substance Abuse Services 1 

Supported Housing Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

 

Funding and Characteristics of State Mental Health Agencies, 2007– South Dakota 179 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the mental health workforce such as 

implementation of Systems of Care and recovery-oriented services and training toward these. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 39 percent. 

Mental health parity laws: 

The state mandates mental health insurance benefits. Only benefits for specific mental health 

diagnoses are included. The following diagnoses are included: Axis I. The mandate includes 

parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Corrections Yes 

Housing No Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Note: Blank space indicates the state did not report data for this category. 

Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. The state did not indicate how many children had their parents’ 

custody relinquished in 2007 in order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine; established telepsychiatry as reimbursable service 

under State Medicaid; also utilizes telemedicine for psychiatric services in correctional mental 

health. 

Electronic Health Records (EHR): 

The state does not use a single EHR system for all community mental health providers. Local 

providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is not within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are no SMHA-operated state psychiatric hospitals.

Funding and Characteristics of State Mental Health Agencies, 2007– South Dakota 180 
The average daily census in FY 2006 for youth was 64 and for adults was 180 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the State National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members. Community mental health centers are actively working with the state 

National Guard to ensure guardsmen and their families receive needed services.

Funding and Characteristics of State Mental Health Agencies, 2007– South Dakota 181 
TENNESSEE 2007 

E425 Fifth Avenue North 

Cordell Hull Building 

5th Floor 

Nashville, TN 37243 

http://www.state.tn.us/mental

The Department of Mental health and Developmental 

Disabilities (DMHDD) contracts with managed care 

organizations for behavioral health care services under the 

TennCare Partners Program, a Medicaid waiver program; 

contracts with community mental health agencies (CMHAs) for 

Mental Health Safety Net (MHSN) services, a clinical services 

program for TennCare disenrolled adults with SMI; and 

contracts with CMHAs and other community entities to provide 

an array of education, prevention, early intervention and 

support programs for children and youth and their families and 

for a variety of recovery programs for adults, persons with cooccurring disorders, and older adults. The Department of 

Children’s Services (DCS) is responsible for provision and 

oversight of services to children in or at risk of state custody.

Statistics: 

State Population (2006): 6,038,803 

Number of Persons Served (2007): 170,727 

Utilization Rate for Adults: 26 per 1,000 

Utilization Rate for Children: 36 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $522 million 

Revenue From Medicaid $355.6 million 

Expenditures for Community Mental Health Services (66% of Total 

Mental Health Agency Revenues) $345.2 million 

Per Capita State Mental Health Expenditures $87.91 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Shared with another agency 

Funding and Characteristics of State Mental Health Agencies, 2007– Tennessee 182 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Part of SMHA 

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 5 0 5 

Community Mental Health Providers 0 48 48 

Private Psychiatric Hospitals NA 2 2 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state 2 

Supported Employment Statewide 7 

Medication Algorithms (Schizophrenia) Pilot program 1 

Integrated MH/Substance Abuse Services Parts of the state 10 

Self-Management Parts of the state 1 

Supported Housing Statewide 10 

Consumer-Operated Services Statewide 48 

Multisystemic Therapy (Conduct Disorder) Parts of the state 1 

Therapeutic Foster Care Statewide 4 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of 

Programs 

Better Attitudes and Skills in Children (BASIC) Statewide 43 

Regional Intervention Program (RIP) Parts of state 14 

Peer Support Centers Statewide 48 

Peer Specialists Parts of state 32 

Funding and Characteristics of State Mental Health Agencies, 2007– Tennessee 183 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the mental health workforce, generally 

through training of current workforce, resident programs, and liaison with colleges/universities. 

The department works with the Tennessee Department of Health in the identification of critical 

shortage areas for mental health professionals across the state. In addition, several DMHDD staff 

work in conjunction with the Governor’s Office of Children’s Care Coordination, Tennessee 

Adolescent Coordination of Treatment (T-ACT) project on workforce development. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid Research and Demonstration 

(1115) waiver. State’s share of the Medicaid match is 35 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid 

Writing waiver SMHA has no responsibility 

Contracting SMHA jointly responsible with Medicaid 

Monitoring SMHA jointly responsible with Medicaid 

Evaluating SMHA jointly responsible with Medicaid 

SMHA serves as managed care agent SMHA jointly responsible with Medicaid 

Mental health parity laws: 

The State mandates mental health insurance benefits. These benefits include any mental health 

service, but not substance abuse services. The following diagnoses are included: limited parity 

covering number of visits and lifetime maximums but not copays, coinsurance, deductibles. The 

mandate includes parity with physical health service benefits. 

Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. There were no children who had their parents’ custody 

relinquished in 2007 in order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. 

Electronic Health Records (EHR): 

The SMHA is in the process of installing an EHR in state hospitals. The state does not use a 

single EHR system for all community mental health providers. Local providers use a variety of 

EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are five SMHA-operated state psychiatric hospitals. 

Funding and Characteristics of State Mental Health Agencies, 2007– Tennessee 184 
SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes 

Adolescents Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

State psychiatric hospital patient legal status: 

Note: Percentage may not total 100 because of rounding. 

Psychiatric inpatient bed shortages: 

There have been declines in state psychiatric hospital beds in the last 5 years. The state is not 

experiencing a shortage of psychiatric beds.

Funding and Characteristics of State Mental Health Agencies, 2007– Tennessee 185 
TEXAS 2007 

Department of State Health 

Services 

909 W. 45th Street 

Mail Code 2018 

P.O. Box 149347 

Austin, TX 78714-9347 

http://www.dshs.state.tx.us/m

entalhealth.shtm

The Department of State Health Service (DSHS) 

administers substance abuse services and public health 

services. Community mental health Services for adults and 

children are administered through 38 Local Mental 

Health Authorities (LMHAs).

Statistics: 

State Population (2006): 23,507,783 

Number of Persons Served (2007): 240,443 

Utilization Rate for Adults: 11 per 1,000 

Utilization Rate for Children: 7.0 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $832.2 million 

Revenue From Medicaid $186.3 million 

Expenditures for Community Mental Health Services (66% of Total 

Mental Health Agency Revenues) $503.6 million 

Per Capita State Mental Health Expenditures $36.47 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status No responsibility 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Texas 186 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department as the SMHA 

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Part of SMHA 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 9 3 12 

Community Mental Health Providers 0 38 38 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state 17 

Supported Employment Statewide 38 

Medication Algorithms (Schizophrenia) Statewide 38 

Medication Algorithms (Bipolar Disorders) Statewide 38 

Family Psychoeducation Statewide 0 

Integrated MH/Substance Abuse Services Statewide 38 

Self-Management Statewide 38 

Supported Housing Statewide 38 

Consumer-Operated Services Parts of the state 10 

Multisystemic Therapy (Conduct Disorder) Parts of the state 2 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the mental health workforce. DSHS has a 

Training and Technical Assistance Unit that develops and provides training to build the 

professional capacity of individuals and organizations in the field to deliver quality services 

more successfully and increase staff effectiveness. The Training and Technical Assistance Unit 

is responsible for the development of new trainings and technical assistance protocols based on 

assessments and input from providers, stakeholders, and staff in other units. 

Funding and Characteristics of State Mental Health Agencies, 2007– Texas 187 
Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. 

State’s share of the Medicaid match is 39 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency

Writing waiver SMHA jointly responsible with Medicaid agency 

Contracting SMHA jointly responsible with Medicaid agency 

Monitoring SMHA jointly responsible with Medicaid agency 

Evaluating SMHA jointly responsible with Medicaid agency 

SMHA serves as managed care agent SMHA jointly responsible with Medicaid agency 

Mental health parity laws: 

The State mandates mental health insurance benefits. Only benefits for specific mental health 

diagnoses are included. 

The following diagnoses are included: Certain health plans regulated by the Texas Department of 

Insurance are required to provide coverage for the treatment of bipolar disorder, schizophrenia, 

schizoaffective disorder, major depressive disorder, obsessive compulsive disorder, pervasive 

developmental disorder, paranoia, psychosid, and childhood depression. Texas law requires that 

group insurance coverage for mental illness provide up to 45 days of inpatient and 60 days of 

outpatient treatment; see: http://www.tdi.tx.us/pbs/consumer/cb005.html. 

The mandate does not include parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education Yes Yes 

Juvenile Justice Yes Yes 

Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. There were 300 children who had their parents’ custody 

relinquished in 2007 in order to receive mental health services. 

Funding and Characteristics of State Mental Health Agencies, 2007– Texas 188 
Telemedicine: 

The SMHA promotes the use of telemedicine. Texas has long allowed physician-to-physician 

consultations via telemedicine and the State Mental Health Authority has allowed Local Mental 

Health Authorities to utilize telemedicine as a means of delivering telemedicine services for 

several years. 

Electronic Health Records (EHR): 

The SMHA is in the process of installing an EHR in community mental health programs. The 

SMHA has implemented all EHR components in state hospitals. The state does not use a single 

EHR system for all community mental health providers. Local providers use a variety of EHR 

systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency responsible

for the funding and/or delivery of community‐based mental health services. There are nine SMHA‐

operated state psychiatric hospitals.

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 356 and adults were 1,885 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Funding and Characteristics of State Mental Health Agencies, 2007– Texas 189 
Funding and Characteristics of State Mental Health Agencies, 2007– Texas 190 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the Federal Department of Veterans Affairs to assure the provision 

of services to meet the mental health needs of veterans and National Guard members. Some 

initial coordination and planning activities have taken place with DVA. Discussions are focused 

on information sharing and coordination.
UTAH 2007 

Division of Substance 

Abuse and Mental Health 

Department of Human 

Services 

120 North 200 West 

Salt Lake City, UT 84103

Utah’s Division of Substance Abuse and Mental Health is 

authorized under Utah State statute Section 62A-15-103 to be the 

substance abuse and mental health authority for the state. As the 

mental health authority, the Division is charged with maintenance 

and oversight of the State Hospital and the responsibility to contract 

with local mental health authorities who administer public mental 

health care through community mental health centers. The Division 

is one of eight divisions and offices under the Department of Human 

Services, but falls under the policy direction of the governorappointed Board of Substance Abuse and Mental Health. Under 

Utah State Statute Section 17-43-301 local mental health authorities 

are responsible for the provision of mental health services to their 

citizens. A local mental health authority is generally the governing 

body of a county. Several of Utah’s rural and frontier counties have 

joined together to provide mental health services through a single 

community mental health center. Utah has 11 community mental 

health centers with 4 of the centers organized as private nonprofit 

corporations and seven organized under interlocal agreements.

Statistics: 

State Population (2006): 2,550,063 

Number of Persons Served (2007): 38,658 

Utilization Rate for Adults: 14 per 1,000 

Utilization Rate for Children: 17 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $159.9 million

Revenue From Medicaid $106.8 million 

Expenditures for Community Mental Health Services (71% of Total 

Mental Health Agency Revenues) $113.1 million 

Per Capita State Mental Health Expenditures $64.34 

Funding and Characteristics of State Mental Health Agencies, 2007– Utah 191 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA:

Agency Location 

State Medicaid Agency Located in a different state department

Substance Abuse Agency Part of SMHA 

State Housing Department Located in a different state department 

State Health Department Located in a different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 1 1 

Community Mental Health Providers 0 13 13 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Funding and Characteristics of State Mental Health Agencies, 2007– Utah 192 
Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state 3 

Supported Employment Statewide 7 

Medication Algorithms (Schizophrenia) Parts of the state 

Medication Algorithms (Bipolar Disorders) Parts of the state 

Family Psychoeducation Statewide 11 

Integrated MH/Substance Abuse Services Parts of the state 2 

Self-Management Parts of the state 11 

Supported Housing Parts of the state 8 

Consumer-Operated Services Parts of the state 3 

Multisystemic Therapy (Conduct Disorder) Parts of the state 1 

Therapeutic Foster Care 1 

Functional Family Therapy Parts of the state 2 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of 

Programs 

School-Based Available in parts of state 6 

Consumer-Run Services Available in parts of state 

Trauma-Based Care Available in parts of state 

Wellness Clinics Available in parts of state 4 

Person‐Centered Planning Available in parts of state 13 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. 

Managed behavioral healthcare: 

Mental health services are being delivered via managed care. These behavioral health services 

are administered through a Medicaid 1915(b) waiver. 

State’s share of the Medicaid match is 63 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has no responsibility

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA has lead responsibility 

Evaluating SMHA has no responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Funding and Characteristics of State Mental Health Agencies, 2007– Utah 193 
Mental health parity laws: 

The state mandates mental health insurance benefits. 

The mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Health Yes No 

Education Yes Yes 

Juvenile Justice Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. There were no children who had their parents’ custody 

relinquished in 2007 in order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine; assisting all rural centers to purchase and use 

telehealth equipment. 

Electronic Health Records (EHR): 

The SMHA has implemented all EHR components in state hospitals and community mental 

health programs. The state does not use a single EHR system for all community mental health 

providers. Local providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one SMHA-operated state psychiatric hospital. 

SMHA currently uses its state psychiatric hospital beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes 

Adolescents Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes 

The average daily census in FY 2006 for youth was 64 and for adults was 253 receiving state 

psychiatric inpatient care. 

Funding and Characteristics of State Mental Health Agencies, 2007– Utah 194 
State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in general 

hospital specialty unit psychiatric beds in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the State National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members. 

Funding and Characteristics of State Mental Health Agencies, 2007– Utah 195 
VERMONT 2007 

Agency of Human 

Services 

Department of Mental 

Health 

108 Cherry Street 

Burlington, VT 05402

The restored Department of Mental Health (DMH) contracts with 

community providers of mental health services for adults with 

severe mental illness and for children and adolescents experiencing 

a serious emotional disturbance and their families. The public 

mental health system has 10 Commissioner-designated nonprofit 

agencies (designated agencies, or DAs) located in all major 

geographic areas of Vermont. Many of those agencies have more 

than one office to serve their respective catchment areas. DMH’s 

central office provides leadership and direction for the communitybased public mental health system as well as program and service 

monitoring and assessment to assure adherence to state and 

Federal regulations and to manage the quality of services and 

supports delivered by DAs. DMH also operates the Vermont State 

Hospital (VSH), Vermont’s only public psychiatric hospital. 

Inpatient psychiatric services at VSH are the only services that 

DMH provides directly. Additionally, DMH contracts with five 

designated hospitals (DHs) for emergency inpatient psychiatric 

assessment and treatment of adults in need of acute hospitalization. 

DHs also provide voluntary inpatient psychiatric services and 

limited partial hospitalization.

Statistics: 

State Population (2006): 623,908 

Number of Persons Served (2007): 20,806 

Utilization Rate for Adults: 24 per 1,000 

Utilization rate for Children: 67 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $109 million 

Revenue From Medicaid $85.7 million 

Expenditures for Community Mental Health Services (83% of Total 

Mental Health Agency Revenues) $90.6 million 

Per Capita State Mental Health Expenditures $175.16 

Funding and Characteristics of State Mental Health Agencies, 2007– Vermont 196 
Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Shared with another agency

Elderly Mental Health Services Shared with another agency 

Adult Forensic Mental Health Services Shared with another agency 

Brain Impaired Services (including Traumatic Brain Injuries) Shared with another agency 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Same umbrella department as the SMHA

Substance Abuse Agency Same umbrella department as the SMHA 

State Housing Department Same umbrella department as the SMHA 

State Health Department Same umbrella department as the SMHA 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 1 0 1 

Community Mental Health Providers 11 0 11 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 4 4 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies. 

Funding and Characteristics of State Mental Health Agencies, 2007– Vermont 197 
Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state 1 

Supported Employment Statewide 10 

Family Psychoeducation Parts of the state 2 

Integrated MH/Substance Abuse Services Statewide 10 

Self-Management Parts of the state 1 

Supported Housing Statewide 10 

Consumer-Operated Services Parts of the state 

Therapeutic Foster Care Statewide 1 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation 

Recovery Education Available statewide 

Dialectical Behavioral Therapy Available in parts of state 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; agency of Human 

Services Quality Council; unifying across departments and divisions. 

Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid Research and Demonstration 

(1115) waiver. State’s share of the Medicaid match is 39 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency

Writing waiver SMHA jointly responsible with Medicaid agency 

Contracting SMHA jointly responsible with Medicaid agency 

Monitoring SMHA jointly responsible with Medicaid agency 

Evaluating SMHA jointly responsible with Medicaid agency 

SMHA serves as managed care agent SMHA jointly responsible with Medicaid agency 

Mental health parity laws: 

There is no mandate, but Vermont did pass the country’s first parity law in 1997. The mandate 

includes parity with physical health service benefits. The SMHA does not mandate mental health 

insurance benefits. 

Funding and Characteristics of State Mental Health Agencies, 2007– Vermont 198 
Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes 

Health No Yes 

Housing Yes 

Education Yes 

Juvenile Justice Yes 

Child Welfare Yes Yes 

Note: Blank space indicates the state did not report data for this category. 

Custody relinquishment: 

There were no children who had their parents’ custody relinquished in 2007 in order to receive 

mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals. The SMHA has some EHR 

components implemented in state hospitals. The state does not use a single EHR system for all 

community mental health providers. Local providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one SMHA-operated state psychiatric hospital. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 1 and for adults was 50 receiving state 

psychiatric inpatient care. 

Psychiatric inpatient bed shortages: 

There have been declines in general hospital specialty unit psychiatric beds in the last year. The 

state is not experiencing a shortage of psychiatric beds.

Funding and Characteristics of State Mental Health Agencies, 2007– Vermont 199 
Funding and Characteristics of State Mental Health Agencies, 2007– Vermont 200 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the Federal Department of Veterans Affairs to assure the provision 

of services to meet the mental health needs of veterans and National Guard members; 

information exchange between designated agencies and Veterans Affairs.
VIRGINIA 2007 

Department of Mental Health, 

Mental Retardation and Substance 

Abuse Services 

1220 Bank Street 

Richmond, VA 23218 

http://www.dmhmrsas.virginia.gov

Virginia’s public mental health, mental retardation and 

substance abuse services system is comprised of forty 

community services boards (CSBs) and sixteen state 

facilitates. The CSBs and state facilities serve children and 

adults who have or who are at risk of mental illness, 

serious emotional disturbance, mental retardation, or 

substance use disorders.

Statistics: 

State Population (2006): 7,642,884 

Number of Persons Served (SFY2006): 121,696 

Utilization Rate for Adults: 16 per 1,000 

Utilization Rate for Children: 15 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $531.5 million

Revenue From Medicaid $155.6 million 

Expenditures for Community Mental Health Services (42% of Total 

Mental Health Agency Revenues) $223.9 million 

Per Capita State Mental Health Expenditures $72.62 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services Shared with another agency 

Court Evaluation of Mental Health Status Shared with another agency 

Services to Persons With Mental Illness in Prison/Jail Shared with another agency 

Sex Offender Services Shared with another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Shared with another agency 

Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Different state department

Substance Abuse Agency Part of SMHA 

State Housing Department Different state department 

State Health Department Different state department 

Funding and Characteristics of State Mental Health Agencies, 2007– Virginia 201 
The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 11 0 11 

Community Mental Health Providers 0 40 40 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state 18 

Supported Employment Parts of the state 1 

Integrated Mh/Substance Abuse Services Parts of the state 548 

Supported Housing Parts of the state 1 

Consumer-Operated Services Parts of the state 

Multisystemic Therapy (Conduct Disorder) Parts of the state 4 

Therapeutic Foster Care Parts of the state 1 

Functional Family Therapy Parts of the state 1 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation 

Peer-Provided and Consumer-Run Services Available in parts of state 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. Currently, direct 

support staff and others are being provided the College of Direct Support Curriculum, which is a 

web-based training program targeted at best practices in the field of disabilities. Competency 

checkoffs are required to ensure learners are competent in skills, thus enhancing services to 

customers and the competences of the workforce. A direct support career pathway has been 

developed in partnership with the College of Direct Support, John Tyler Community College, 

and the Virginia Community College System providing for continuing education and career 

studies certificates in mental health, developmental disabilities and human services. Workforce 

and Cultural Competency Conference held October 2007. 

Funding and Characteristics of State Mental Health Agencies, 2007– Virginia 202 
Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. 

State’s share of the Medicaid match is 50 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has no responsibility 

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA has no responsibility 

Evaluating SMHA has no responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Mental health parity laws: 

The state mandates mental health insurance benefits. Only benefits for specific mental health 

diagnoses are included. There has been no change from previous reportregarding diagnoses 

included. The mandate includes parity with physical health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes No 

Corrections No Yes 

Education Yes No 

Juvenile Justice No Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: Virginia law does not require parent to 

relinquish custody in order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine; installation of video teleconferencing at all staterun and local community providers. 

Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals and community mental 

health programs. The SMHA has some EHR components implemented in state hospitals and 

community mental health programs. The state does not use a single EHR system for all 

community mental health providers. Local providers use a variety of EHR systems. 

Funding and Characteristics of State Mental Health Agencies, 2007– Virginia 203 
State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one SMHA-operated state psychiatric hospital. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 63 and for adults was 1,464 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in general 

hospital specialty unit psychiatric, state psychiatric hospital, and private psychiatric hospital beds 

in the last 5 years. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the State National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members; collaboration and planning underway.

Funding and Characteristics of State Mental Health Agencies, 2007– Virginia 204 
WASHINGTON 2007 

P.O. Box 45320 

Olympia, WA 98501 

http://www1.dshs.wa.gov/Mentalhealth

Adults: The Mental Health Division (MHD) is a 

division within the Health and Recovery Services 

Administration (HRSA) within the Department of 

Social and Health Services (DSHS). MHD operates an 

integrated system of care for people with mental illness 

who are enrolled in Medicaid as well as for those 

individuals who qualify as “low income”who also meet 

the statutory need requirements.

Statistics: 

State Population (2006): 6,395,798 

Number of Persons Served (2007): 123,614 

Utilization Rate for Adults: 19 per 1,000 

Utilization Rate for Children: 22 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $585.5 million

Revenue From Medicaid $505.1 million 

Expenditures for Community Mental Health Services (67% of Total 

Mental Health Agency Revenues) $395.4 million 

Per Capita State Mental Health Expenditures $93.96 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Responsibility for services shared with another 

agency

Elderly Mental Health Services Responsibility for services shared with another 

agency 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic 

Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain 

Syndrome Services 

Responsibility for services shared with another 

agency 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in 

Prison/Jail 

Responsibility for services shared with another 

agency 

Sex Offender Services No responsibility 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Washington 205 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in the same umbrella department as the SMHA 

Substance Abuse Agency Located in the same umbrella department as the SMHA 

State Housing Department Located in a different state department 

State Health Department Located in a different state department 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State psychiatric hospitals 3 0 3 

Community Mental Health Providers 0 126 126 

Private Psychiatric Hospitals NA 3 3 

General Hospitals With Separate Psychiatric Units 0 22 22 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of programs 

Assertive Community Treatment (ACT) Parts of the state 9 

Supported Employment Parts of the state 7 

Medication Algorithms (Schizophrenia) Parts of the state 1 

Medication Algorithms (Bipolar Disorders) Parts of the state 1 

Family Psychoeducation Parts of the state 3 

Integrated MH/Substance Abuse Services Parts of the state 2 

Supported Housing 10 

Consumer-Operated Services Parts of the state 10 

Multisystemic Therapy (Conduct Disorder) Pilot program 3 

Therapeutic Foster Care Parts of the state 4 

Functional Family Therapy Parts of the state 10 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; training through 

Washington Institute for Mental Illness Research and Training. 

Managed behavioral healthcare: 

Mental health services are being delivered via managed care. These behavioral health services 

are administered through a Medicaid 1915(b) waiver. State’s share of the Medicaid match is 50 

percent. 

Funding and Characteristics of State Mental Health Agencies, 2007– Washington 206 
The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA has lead responsibility

Writing waiver SMHA has lead responsibility 

Contracting SMHA has lead responsibility 

Monitoring SMHA has lead responsibility 

SMHA serves as managed care agent SMHA has lead responsibility 

Mental health parity laws: 

The State mandates mental health insurance benefits. The mandate does not include parity with 

physical health service benefits. State expanded mental health parity laws in 2007 requiring 

insurance policies issued for all individuals, groups, and the Washington State Health Insurance 

Pool to include coverage for mental health services equal to coverage for medical and surgical 

services. 

 Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections No Yes 

Child Welfare No Yes 

Custody relinquishment: 

DSHS coordinates among all involved state agencies, including the Children’s Administration, 

state Medicaid program, and HRSA/MHD/SMHA to assure custodial relinquishment is avoided 

to the maximum extent possible. For example, Washington State has assured through statute that 

youth 13 and above who desire mental health services may obtain such services, whether 

outpatient or inpatient, on their own authority. 

Telemedicine: 

The SMHA promotes the use of telemedicine. Telemedicine is supported through the payment of 

Medicaid rates for identified services available through the state Medicaid plan. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are three SMHA-operated state psychiatric hospitals. 

Funding and Characteristics of State Mental Health Agencies, 2007– Washington 207 
The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 83 and for adults was 1,284 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in general 

hospital specialty unit psychiatric beds in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA, WADVA, DASA, Governor’s Policy Office, National Guard, Employment 

Security, and Mothers of Military Support jointly applied for and were selected to participate in 

the 2008 Returning Veterans and Their Families Strategic Planning Conference and Policy 

Academy. Objectives of the Federal grant program include assisting states to develop 

interventions addressing mental health, substance abuse, and co-occurring issues specific to 

returning veterans and their families; strengthening behavioral health systems through 

collaboration; fostering veteran-to-veteran peer support networks; and suicide prevention. 

The SMHA is collaborating with WADVA combat PTSD experts to identify and implement 

strategies to enhance mental health practitioner war trauma treatment competencies to assure that 

provision of services meets the mental health needs of veterans and National Guard members.

Funding and Characteristics of State Mental Health Agencies, 2007– Washington 208 
WEST VIRGINIA 2007 

Bureau for Behavioral 

Health and Health 

Facilities 

Department of Health 

and Human Resources 

350 Capitol Street 

Room 350 

Charleston, WV 25301 

The West Virginia Bureau for Behavioral Health and Health 

Facilities (BHHF) serves as the state authority for the behavioral 

health system and provides funding for community-based behavioral 

health services for persons with behavioral health needs, including 

those who do not have the benefit or the means to purchase services. 

Within BHHF are two separate, but interrelated offices the Office of 

Behavioral Health Services (OBHS) and the Office of Health 

Facilities (OHF). The OHF provides oversight and coordination of 

planning, development, funding, and monitoring of state psychiatric 

and long-term care facilities.

Statistics: 

State Population (2006): 1,818,470 

Number of Persons Served (2007): 58,918 

Utilization Rate for Adults: 29 per 1,000 

Utilization Rate for Children: 45 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY 2005) Dollars 

Total Mental Health Agency-Controlled Revenue $119.4 million 

Revenue From Medicaid $44.1 million 

Expenditures for Community Mental Health Services (59% of Total 

Mental Health Agency Revenues) $70.7 million 

Per Capita State Mental Health Expenditures $65.84 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA 

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic 

Brain Injuries) 

Responsibility for services is shared with 

another agency 

Alzheimer’s Disease and Organic Brain 

Syndrome Services 

Responsibility for services is shared with 

another agency 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in 

Prison/Jail No responsibility 

Sex Offender Services Responsibility for services is shared with 

another agency 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– West Virginia 209 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in the same umbrella department as the SMHA

Substance Abuse Agency Part of SMHA 

State Housing Department Located in a different state department 

State Health Department Located in the same umbrella department as the SMHA 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 2 0 2 

Community Mental Health Providers 0 13 13 

Nursing Homes and Other ICF-MI and SNF Providers 4 0 4 

Primary mechanism in delivering mental health services: 

SMHA directly funds but does not operate local community-based agencies.

Evidence-based services: 

Evidence-Based Practice Implementation Number of Programs 

Assertive Community Treatment (ACT) Parts of the state 3 

Supported Employment Parts of the state 7 

Family Psychoeducation 1 

Integrated MH/Substance Abuse Services Parts of the state 4 

Self-Management Parts of the state 2 

Supported Housing Parts of the state 2 

Consumer-Operated Services Parts of the state 10 

Therapeutic Foster Care Parts of the state 

Note: Blank space indicates the state did not report data for this category. 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of Programs 

Suicide Prevention Available in parts of state 2 

Leadership Academy Available in parts of state 1 

Recovery Education Available in parts of state 1 

Suicide Prevention Available in parts of state 1 

Funding and Characteristics of State Mental Health Agencies, 2007– West Virginia 210 
Workforce development initiatives: 

The SMHA has initiatives to improve the quality of the the mental health workforce; uses block 

grant funds to support consumer networks to train peer support specialists to achieve certification 

while earning college credits. The outcome will allow access to jobs with mental health agencies. 

Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. State’s 

share of the Medicaid match is 27 percent. 

Mental health parity laws: 

The state mandates mental health insurance benefits. Only benefits for specific mental health 

diagnoses are included. The following diagnoses are included: Adults—schizophrenia, bipolar, 

depression, anxiety, anorexia and bulimia and addiction. Children—ADHD, separation anxiety, 

and conduct disorders. The mandate includes parity with physical health service benefits. 

Custody relinquishment: 

The state does not have laws or policies designed to avoid parents having to relinquish custody 

of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to 

obtain mental health services. The state did not indicate how many children had their parents’ 

custody relinquished in 2007 in order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. SMHA is working with Medicaid to expand 

access to telemedicine via expanded reimbursement for services in rural areas of West Virginia. 

Electronic Health Records (EHR): 

The SMHA is in the process of installing an EHR in state hospitals. The state does not use a 

single EHR system for all community mental health providers. Local providers use a variety of 

EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are two SMHA-operated state psychiatric hospitals. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

Funding and Characteristics of State Mental Health Agencies, 2007– West Virginia 211 
State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in general 

hospital specialty unit psychiatric beds in the last 5 years. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the Federal Department of Veterans Affairs to assure the provision 

of services to meet the mental health needs of veterans and National Guard members. The 

SMHA is working with the Council of Churches in an ongoing manner, which will include a 

summit to be held for returning veterans and their families.

Funding and Characteristics of State Mental Health Agencies, 2007– West Virginia 212 
WISCONSIN 2007 

Division of Mental Health 

and Substance Abuse 

Services 

Department of Health 

Services 

1 West Wilson Street, 

Room 455 

Madison, WI 53707

Wisconsin employs a strong county-based human service system. 

The public mental health system is administered through 72 county 

program boards. Direct services are primarily provided by the 

county or local private providers contracted by the county. The 

Division of Mental Health and Substance Abuse Services 

(DMHSAS) is the state mental health agency that works directly 

with county mental health agencies.

Statistics: 

State Population (2006): 5,556,506 

Number of Persons Served (2007): 84,890 

Utilization Rate for Adults: 17 per 1,000 

Utilization Rate for Children: 9 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY2005) Dollars 

Total Mental Health Agency-Controlled Revenue $579.7 million

Revenue From Medicaid $135.5 million 

Expenditures for Community Mental Health Services (72% of Total 

Mental Health Agency Revenues) $417.6 million 

Per Capita State Mental Health Expenditures $104.9 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Part of the SMHA 

Brain Impaired Services (including Traumatic Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Part of the SMHA 

Services to Persons With Mental Illness in Prison/Jail No responsibility 

Sex Offender Services Part of the SMHA 

State Mental Hospitals Part of the SMHA 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Wisconsin 213 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in the same umbrella department as the SMHA

Substance Abuse Agency Part of SMHA 

State Housing Department Located in a different state department 

State Health Department Located in the same umbrella department as the SMHA 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 2 1 3 

Community Mental Health Providers 0 67 67 

Private Psychiatric Hospitals NA 0 0 

General Hospitals With Separate Psychiatric Units 0 0 0 

Nursing Homes and Other ICF-MI and SNF Providers 0 0 0 

NA = not applicable 

Primary mechanism in delivering mental health services: 

SMHA funds county or city mental health authorities statewide. 

Evidence-based services: 

Evidence-Based Practice Implementation Number of 

Programs 

Assertive Community Treatment (ACT) Parts of the state 79 

Supported Employment Parts of the state 47 

Family Psychoeducation Parts of the state 31 

Integrated MH/Substance Abuse Services Parts of the state 56 

Self-Management Parts of the state 43 

Supported Housing Statewide 48 

Consumer-Operated Services Statewide 10 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of 

Programs 

Wraparound Systems of Care Available in parts of state 36 

Psychosocial Rehab Services (Child/Adolescent) Available in parts of state 9 

Psychosocial Rehab Services (Adults) Available in parts of state 20 

Consumer-Run Services Available in parts of state 12 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce. Annual statewide 

training conference, monthly training teleconferences with experts; establishment of a Center for 

Best Practices Development with the University of Wisconsin and The Wisconsin Medical 

College. 

Funding and Characteristics of State Mental Health Agencies, 2007– Wisconsin 214 
Managed behavioral healthcare: 

Mental health and substance abuse services are being delivered via managed care. These 

behavioral health services are administered through a Medicaid 1915(b) waiver. 

State’s share of the Medicaid match is 41 percent. 

The SMHA’s role in monitoring and managing the mental health/behavioral health benefits: 

Task Responsibility 

Designing the mental health benefit system SMHA jointly responsible with Medicaid agency

Writing waiver SMHA has no responsibility 

Contracting SMHA has no responsibility 

Monitoring SMHA has no responsibility 

Evaluating SMHA has no responsibility 

SMHA serves as managed care agent SMHA has no responsibility 

Mental health parity laws: 

The state mandates minimum mental health insurance benefits. These benefits include a range of 

mental health and substance abuse service. The mandate does not include parity with physical 

health service benefits. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Medicaid Yes Yes 

Corrections Yes Yes 

Health Yes Yes 

Housing Yes Yes 

Education No Yes 

Juvenile Justice No Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state does not have specific laws or policies designed to avoid parents having to relinquish 

custody of children (to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them 

to obtain mental health services. There were no children who had their parents’ custody 

relinquished in 2007 in order to receive mental health services. 

Telemedicine: 

The SMHA promotes the use of telemedicine. Telehealth is a Medicaid benefit that the SMHA 

promotes to local providers.

Funding and Characteristics of State Mental Health Agencies, 2007– Wisconsin 215 
Electronic Health Records (EHR): 

The SMHA is considering the adoption of an EHR in state hospitals and community mental 

health programs. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There 

are two SMHA-operated state psychiatric hospitals. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Children Yes Yes Yes 

Adolescents Yes Yes Yes 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for youth was 82 and for adults was 411 receiving state 

psychiatric inpatient care. 

State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in general 

hospital specialty unit psychiatric, state psychiatric hospital and private psychiatric hospital beds 

in the last year. 

Services for Armed Forces veterans and National Guard members: 

The SMHA works with the Federal Department of Veterans Affairs on training counties and 

providers to assure the provision of services to meet the mental health needs of veterans and 

National Guard members.

Funding and Characteristics of State Mental Health Agencies, 2007– Wisconsin 216 
WYOMING 2007 

Mental Health and 

Substance Abuse Services 

Division 

Wyoming Department 

of Health 

6101 N. Yellowstone Road 

Suite 220 

Cheyenne, WY 82002

The Wyoming public mental health system is of the Mental Health 

Division (MHD), 15 community mental health centers (CMHCs), 

and the Wyoming State Hospital (WSH). The Mental Health 

Division, as the state mental health authority, oversees the 

operations of community mental health centers and acts as the 

conduit for state and Federal funding for community mental health 

services.

Statistics: 

State Population (2006): 515,004 

Number of Persons Served (2007): 18,081 

Utilization Rate of Adults: 32 per 1,000 

Utilization Rate for Children: 45 per 1,000 

Revenues and expenditures: 

Revenues and Expenditures (FY2005) Dollars 

Total Mental Health Agency-Controlled Revenue $49.9 million

Revenue From Medicaid $7.7 million 

Expenditures for Community Mental Health Services (68% of Total 

Mental Health Agency Revenues) $34.2 million 

Per Capita State Mental Health Expenditures $98.79 

Responsibilities of the SMHA in administering specific mental health services: 

Services Arena Responsibility 

Children and Youth Mental Health Services Part of the SMHA

Elderly Mental Health Services Part of the SMHA 

Adult Forensic Mental Health Services Responsibility of services shared with another 

agency 

Brain Impaired Services (including Traumatic 

Brain Injuries) No responsibility 

Alzheimer’s Disease and Organic Brain 

Syndrome Services No responsibility 

Court Evaluation of Mental Health Status Responsibility of services shared with another 

agency 

Services to Persons With Mental Illness in 

Prison/Jail 

Responsibility of services shared with another 

agency 

Sex Offender Services No responsibility 

State Mental Hospitals Responsibility of services shared with another 

agency 

Community Mental Health Program Part of the SMHA 

Funding and Characteristics of State Mental Health Agencies, 2007– Wyoming 217 
Location of other state agencies in relation to the SMHA: 

Agency Location 

State Medicaid Agency Located in the same umbrella department as the SMHA

Substance Abuse Agency Located in the same umbrella department as the SMHA 

State Housing Department Located in a different state department 

State Health Department Located in the same umbrella department as the SMHA 

The number of mental health providers the SMHA operates or funds: 

Mental Health Providers SMHAOperated 

SMHAFunded Total 

State Psychiatric Hospitals 1 0 1 

Community Mental Health Providers 0 15 15 

Primary mechanism in delivering mental health services: 

SMHA directly funds, but does not operate local community-based agencies 

Evidence-based services: 

Evidence-Based Practice Implementation 

Assertive Community Treatment (ACT) Parts of the state 

Supported Employment Parts of the state 

Medication Algorithms (Schizophrenia) Parts of the state 

Family Psychoeducation Parts of the state 

Integrated Mh/Substance Abuse Services Statewide 

Self-Management Statewide 

Supported Housing Parts of the state 

Consumer-Operated Services Parts of the state 

Multisystemic Therapy (Conduct Disorder) Pilot program 

Therapeutic Foster Care Parts of the state 

Emerging evidence-based and innovative practices: 

Evidence-Based Practice Implementation Number of Programs 

Wraparound Services Available in parts of state 15 

Psychosocial Rehab Available in parts of state 7 

Consumer-Run Services 9 

Gatekeeping Available in parts of state 1 

Note: Blank space indicates the state did not report data for this category. 

Workforce development initiatives: 

The SMHA has initiatives to improve the quality of mental health workforce; periodic training 

events. 

Funding and Characteristics of State Mental Health Agencies, 2007– Wyoming 218 
Managed behavioral healthcare: 

Neither mental health nor substance abuse services are being delivered via managed care. 

State’s share of the Medicaid match is 49 percent. 

Interagency collaboration: 

The SMHA has the following initiatives with other state government agencies to coordinate, 

reduce, or eliminate barriers between delivery systems and funding streams: 

Agency Combine or Coordinate 

Funding Streams 

Combine or Coordinate 

Service Delivery 

Education Yes Yes 

Child Welfare Yes Yes 

Custody relinquishment: 

The state has laws or policies designed to avoid parents having to relinquish custody of children 

(to the SMHA, Child Welfare, or Juvenile Justice Systems) in order for them to obtain mental 

health services. Description of the policies/laws: The Medicaid Children’s Mental Health Waiver 

and the SAMHSA Children and Families System of Care are in place. The waiver project 

predicts that there will be 175 families who will benefit from the waiver over 3 years. There were 

no children who had their parents’ custody relinquished in 2007 in order to receive mental health 

services. 

Telemedicine: 

The SMHA promotes the use of telemedicine; funding telemedicine projects. 

Electronic Health Records (EHR): 

The SMHA has some EHR components implemented in state hospitals and community mental 

health programs. The state does not use a single EHR system for all community mental health 

providers. Local providers use a variety of EHR systems. 

State psychiatric hospitals: 

The responsibility for the operation of state psychiatric hospitals is not within the same agency 

responsible for the funding and/or delivery of community-based mental health services. There is 

one SMHA-operated state psychiatric hospitals. 

The SMHA uses its state psychiatric hospitals beds for: 

Target 

Population 

Acute Inpatient (fewer 

than 30 days) 

Intermediate Inpatient 

(30–90 days) 

Long-Term Inpatient 

(more than 90 days) 

Adults Yes Yes Yes 

Elderly Yes Yes Yes 

Forensic Yes Yes Yes 

The average daily census in FY 2006 for adults was 69 receiving state psychiatric inpatient care. 

Funding and Characteristics of State Mental Health Agencies, 2007– Wyoming 219 
State psychiatric hospital patient legal status: 

Psychiatric inpatient bed shortages: 

The state is experiencing a shortage of psychiatric beds. There have been declines in state 

psychiatric hospital beds in the last 5 years due to new physical plant construction projects. 

Services for Armed Forces veterans and National Guard members: 

The SMHA is working with the state National Guard and the Federal Department of Veterans 

Affairs to assure the provision of services to meet the mental health needs of veterans and 

National Guard members; developing screening instruments.

Funding and Characteristics of State Mental Health Agencies, 2007– Wyoming 220 
HHS Pub. No. (SMA) 09-4424

Printed 2009