Amended Substitute House Bill 317 created Alcohol, Drug Addiction, and Mental Health Services (A.D.A.M.H.S.) Boards in all counties of under 250,000 population. P.C.M.H.R.B. is also known as an A.D.A.M.H.S. Board.

The Mental Health Act is largely based upon the twin values of inclusion and shared responsibility for the mental health service delivery system.

The implementation of the Mental Health Act was designed to be phased in over a period of several years.

At the early juncture, it is apparent that the key fiscal and organizational changes required of the A.D.A.M.H.S. Boards by the Act have been made successfully.

A brief overview of statistics and key events may be useful to understanding where the mental health system was and how it arrived at the Mental Health Act of 1988. According to the Ohio Department of Mental Health's Annual Report for F.Y. 1988:

• In 1988, the number of admissions and discharges to state hospitals were virtually the same as in 1960.
• From 1960, the caseload of Ohio's community mental health agencies had increased by nearly 1000%, from 12,000 to more than 127,000 in 1988.
• In 1960, the average daily cost of care per patient in Ohio's state psychiatric hospitals had risen from less than $10 to more than $180 in 1988.
• In 1988, about 15,000 persons were served in about 4,000 beds in the state psychiatric hospital system. In that same year, 1988, over 127,000 people were served in the community system.
• Hospital costs for care in FY 1988 were about $255.2 million for 15,000 persons served, and community costs were about $302 million for the 127,000 persons served.

The disparities in utilization and O.D.M.H. (Ohio Dept. Mental Health) funding for hospitals compared to communities were obvious. Yet the state, not communities, had financial responsibility for the hospital costs. In the view of some Committee members, there were no financial incentives for communities to avoid state hospitalization.

The Department, and the C.M.H. (Community Mental Health) Boards and agencies, began working actively to develop and test alternative funding mechanisms. Three C.M.H. Boards were chosen as recipients grants from the Robert Wood Johnson Foundation. These awards provided significant financial support and sanction for precisely the type of systems changes at the C.M.H. Board level needed in the state system as a whole.

The Mental Health Act did not appropriate new funds for the mental health system, but rather shifted funds to be available in the locations of people being served by the system.

Much of the intent of the Act revolves around shared responsibility for the mental health delivery system, and the establishment and improvement of mechanisms through which services may be made more responsive to individual need, more available, accessible, appropriate, acceptable, and of higher quality.

Committee Recommendations

• Ensure that effective community services are in place to provide for the needs of those people who would otherwise have been hospitalized.
• Pay special attention to whether funding and policy decisions are unduly influencing patient care decisions.
• Continue to study and monitor the expanded role of Boards in local planning.
• Include all involved local agencies in planning.
• Assure that consumers are involved in significant numbers.
• Continue to monitor Board appointments by O.D.M.H. and encourage county commissioners to increase representation of consumers, family members, and minorities.
• Provide training for consumers and family members on Boards.
• Study the actual costs of serving people with major mental illnesses in the community. Actual costs include any  shifting of care to other systems, expenditures for ancillary and support services from communities, and family financial costs for care.
• Continue to work toward measurement of service outcomes.