Greater coordination of services, as described in the preceding recommendation, can generate savings through reduction in the use of emergency services by individual consumers as well as through more accurate allocation of services, retention in services, and other efficiencies. To facilitate service coordination, there needs to be cooperative policies and administrative support at the system level. State, county, and local mental health authorities either promulgate, or are bound by, financing mechanisms and regulations that can facilitate or impede coordinated service delivery. In most states, for example, licenses for mental health and substance abuse treatment facilities are handled by two different state agencies with separate regulatory, financial, and oversight procedures. Financial incentives encourage front-line providers to do what is reimbursable, rather than what is clinically indicated, while the client suffers the consequences of ineffective care. New inter-organizational structures and policies are required to enable the seamless provision of requisite services. These structural changes do not necessarily require more resources, and coordination has the potential to be cost-efficient. ^[1]   (See Policy Statement 4, Funding a Re-Entry Initiative, for further discussion of generating economic savings by coordinating funding streams and overlapping services.)

Efforts should also be made to ascertain consumers' eligibility for all federal benefits and to ensure enrollment for eligible individuals with mental illnesses. For many people, access to appropriate services is determined by their ability to gain access to health benefits and other entitlements. People with mental illness who are found to be disabled by their illnesses, or who have little or no income as a result of their disability, are eligible for an array of income and reimbursement benefits. Many mental health and addiction services provided by community agencies are reimbursable through Medicaid and Medicare, which are generally available to people who qualify for Supplemental Security Income (SSI) or Social Security Disability Income (SSDI). Qualification for income support also can lead to eligibility for housing supports. In any case, income support through SSI and SSDI provides funds with which an individual can pay rent and meet other basic needs. Other valuable benefits programs for which persons with mental illness may be eligible include Temporary Assistance for Needy Families (TANF), food stamps, and benefits available to veterans through the Veterans Administration.

Just as eligible individuals who are incarcerated often have difficulty enrolling in appropriate government benefits programs, people with mental illnesses sometimes have difficulty obtaining benefits to which they may be entitled. (See Policy Statement 24, Identification and Benefits, for more on improving prisoners' access to federal benefits.) Rules and procedures for disability entitlement programs may be too complex for many consumers to understand. There is also a shortage of staff members at community mental health agencies who are trained to provide assistance to clients who may qualify for federal or state benefits. It is more common than not for first-time applications for entitlements to be denied, at a minimum causing a delay in benefits for qualified applicants. Because these benefits are frequently the only legitimate source of income for many with mental illnesses, such delays can lead to homelessness and such "survival crimes" as panhandling or shoplifting.

To ensure that everyone with mental illnesses receives appropriate care, and to spread the financial burden for mental health care by increasing the flow of federal dollars into the local and state service systems, mental health agencies hire and train staff to provide assistance with applications for SSI, SSDI, and the follow-up that is so often needed to secure these benefits. Further, they should ensure that case managers, employment counselors, rehabilitation therapists, and others who may be working with clients to secure employment are familiar with each client's benefits profile. For some individuals, an increase in income can mean a reduction in, or an end to, benefits. When clients begin work, especially when they are doing so through "transitional employment" or "supported employment" programs, the impact on their benefits should be understood. The rules and regulations applied by the Social Security Administration to these programs can create challenges for staff to provide guidance to clients on entitlement and benefit matters. Training and prioritization of these services, which can be very time consuming, are nonetheless necessary if clients are to obtain supports to help them remain in appropriate treatment and integrate into their communities.