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News and Notes   |    
CSG Justice Center Publication Describes Key Elements of a Mental Health Court
Psychiatric Services 2008; doi:
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The Council of State Governments Justice Center has released an updated edition of Improving Responses to People With Mental Illnesses: The Essential Elements of a Mental Health Court. The publication describes the ten important program elements that jurisdictions should consider when planning, implementing, or enhancing a mental health court.

The number of U.S. mental health courts has steadily grown, from four in 1997 to more than 175, according to Justice Center estimates. But because of the diversity of program models and their relative newness, no criteria for effective mental health courts have been nationally accepted. The publication describes aspects of design and implementation of adult mental health courts that can be consistently found in courts that are considered successful in their communities. The current edition incorporates feedback from professionals and stakeholders at all levels of the criminal justice and mental health systems, including an online public forum and a series of experts' meetings.

For each of the ten elements, criteria are listed that mental health courts should meet, followed by an explanation of why the element is important and how courts can adhere to it. Ultimately, benchmarks will be added, enabling courts to better assess their fidelity to each element. Two key principles underlie the essential elements. First is the necessity for true collaboration among the criminal justice, mental health, substance abuse treatment, and related systems. Second is the fact that mental health courts are not a panacea. Reversing the overrepresentation of people with mental illnesses in the criminal justice system requires a comprehensive strategy of which mental health courts are just one piece.

The 11-page publication, along with additional resources about mental health courts, is available at consensusproject.org/mhcp/info/mhresources/pubs.

Kaiser issue brief on financing Medicare: A 16-page issue brief from the Kaiser Family Foundation describes the two trust funds that finance Medicare and provides an overview of Medicare spending trends. Since the program's inception more than 40 years ago, spending has grown steadily, both in absolute dollars and as a share of the federal budget. In 2007 Medicare's $440 billion in total expenditures represented 16% of all federal outlays, exceeded only by Social Security spending at $577 billion (21%) and military spending at $530 billion (19%). The brief also examines several methods of assessing Medicare's long-term financial outlook, including the recently developed "45% trigger." When actuaries project that within seven years the program's expenditures will exceed dedicated revenue by 45%, this triggers a determination of "excess general revenue funding." If the determination is required for a second consecutive year, a "Medicare funding warning" is issued, which in turn triggers a process requiring responses from the President and Congress. The first Medicare funding warning was issued in 2007, when for the second year in a row officials projected that the 45% threshold would be exceeded within seven years—by 2013. The brief is available on the Kaiser Web site at www.kff.org/medicare/7731.cfm.

AHRQ Web video helps patients communicate with doctors: The Agency for Healthcare Research and Quality (AHRQ) has created a Web video with advice for patients on how to ensure that they obtain the information they need—and understand the information they receive—when they visit their doctor. The five-minute video describes barriers to good communication and reviews questions that patients should ask about medical tests, diagnosis, and medications. Asking the doctor about sensitive topics is also addressed. The video is designed to be used with an AHRQ brochure "Quick Tips When Talking With Your Doctor" and with other resources available on the AHRQ site that encourage people to become active health care consumers. The video is available at www.ahrq.gov/consumer/commdrvid.htm.

APA's online tool promotes effective employer approaches to mental health: The Partnership for Workplace Mental Health, a program of the American Psychiatric Foundation of the American Psychiatric Association (APA), has launched Employer Innovations Online, a Web-based, searchable database that profiles innovative policies, programs, and practices that employers use to address mental health issues. The database includes case studies describing actual practices of leading companies (American Airlines, Cisco Systems, DuPont, JPMorgan Chase, Pitney Bowes, PPG Industries, and Sprint) in key areas, such as screening and education, employee assistance programs, disability management, community partnerships, and wellness programs. The Partnership for Workplace Mental Health invites employer participation. Interested companies and organizations can submit their innovative approaches on the Web site. The database can be accessed at www.workplacementalhealth.org.

Kaiser "snapshot" of wages and benefits: Between 2001 and 2007 the cost of health insurance premiums rose 78%, a much faster rate of increase than the general inflation rate (17%) or than the rate of growth in workers' earnings (19%). An analysis by the Kaiser Foundation indicates that between 1960 and 2006 the total amount spent by employers on group health insurance policies increased more than 20-fold, from $23 billion to $537 billion. Health benefit costs for employers have increased from .6% of GDP in 1960 to 4.1% in 2006. Over the same period wages have fallen from 51.8% of GDP to 45%. The author of the Kaiser analysis notes that although many people feel the burden of health care costs directly when they use medical goods and services, another way that these expenses may affect families' well-being is by slowing the increase in their paychecks each year. Without fundamental change in cost growth or a retreat from U.S. reliance on employer-provided health insurance, the author predicts that these trends are likely to continue. The snapshot analysis is available at www.kff.org.

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