President’s Commission Reports
"Mental Health System Is in Disarray"
Calling the mental health system an inefficient maze of private, Federal, state, and local government programs with scattered responsibility for services that frustrates both people with mental illness and providers of care, the President's New Freedom Commission on Mental Health Chairman Michael F. Hogan, Ph.D., released an interim report to the President this fall.
Citing the need for dramatic reform at all levels of service delivery, Dr. Hogan said, "the Commission's challenge now is to identify realistic solutions to help people with mental illness get the quality care that research has shown to be effective."
The Commission is charged with conducting a comprehensive study of the U.S. mental health service delivery system and advising the President on methods of improving the system to enable adults with serious mental illness and children with serious emotional disturbances to live, work, learn, and participate fully in their communities. As part of that goal, President George W. Bush's April 29, 2002, Executive Order creating the Commission requires this interim report to describe barriers to the delivery of effective mental health care. The report also provides examples of community-based care models that show success in coordinating services and providing desired outcomes.
"Today, people diagnosed with cancer or heart disease benefit from a broad array of effective treatments," Dr. Hogan continued. "People with mental illness deserve no less. Undetected, untreated and poorly treated mental disorders interrupt lives, leading many to disability, poverty, and long-term dependence. The good news is that recovery from mental illness is a reality; a range of safe and effective treatments, services, and supports exist for men, women, and children with mental illness. We know that when mental illness is diagnosed early and treated appropriately, quality of life is tremendously improved. Yet, half of all people who need treatment for mental illness do not receive it. The rate is even lower for racial and ethnic minorities, and the quality of care they receive is poorer."
In its report, the Commission identified barriers to quality care and recovery. Some barriers relate directly to the service delivery system itself, such as fragmentation and gaps in care for children, adults, and older adults. Others encourage dependency through a mix of inadequate rehabilitation services and disincentives to work. Still others reflect a failure to make mental health a national priority. In its next phase of work, the Commission will be addressing ways to break down these barriers to recovery.
Dr. Hogan said, "We need to answer the question, 'Why are 90 percent of adults with serious mental illness unemployed?' After all, studies show that a majority want to work and can work. Instead, our Nation's largest 'program' for people with mental illness is the disability system. Our mental health, rehabilitation, and disability programs unintentionally trap millions of individualswho want to workinto expensive, long-term dependency."
Dr. Hogan continued, "The barriers that keep adults with mental illness from productive work and children with serious emotional disturbance from school success are a tragedy from both human and economic perspectives. Although most adults with mental illness want to work, they are the largest and fastest growing group of people with disabilities receiving Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) payments. An estimated $25 billion is spent annually for this population."
He added, "Many people with mental illness find that they cannot afford to go back to work because they would lose their Medicaid coverage and disability benefits, and despite a job, could not afford private health insurance coverage. Too many people with mental illness are trapped in a 'disability welfare system' that badly serves them and needs reform. And although many children with emotional disorders are very bright, fewer than half ever graduate from high school. Our failure to support employment and school success is a disgrace."
To help identify what works best to provide care for people with mental illness, the Commission has already identified some creative, community-based programs that blend the promise of modern science with the compassion of skilled professionals. These exemplary programs often achieve the best results, despite bureaucracies that frequently create fragmentation instead of focus, and that reward dependency instead of recovery. They range from school-based mental health care in Dallas, to home visits by trained nurses for high-risk women during pregnancy and the first year of their child's life, to suicide prevention by the U.S. Air Force, and effective treatment for late-life depression.
"These models," Dr. Hogan said, "can inspire communities nationwide and provide realistic examples of how quality, coordinated care is possible for the millions of Americans with mental illness."
Overall, the Commission's interim report found that the system is not oriented to the single most important goal of the people it servesthe hope of recovery. Many more individuals could recoverfrom even the most serious mental illnessesif they had access to effective treatments tailored to their needs, and to supports and services in their communities. State-of-the-art treatments, based on decades of scientific inquiry, are not being transferred from research to community settings. At the same time, many outdated and ineffective treatments are still used.
Michael Hogan, Chairman of the President's New Freedom Commission on Mental Health, presented findings from the Commission's Interim Report. (Photo by Catherine Brown)
The President tasked the Commission to recommend improvements in the mental health service system and requested a review of both public and private sectors to identify policies that could be implemented by Federal, state, and local governments to maximize the utility of existing resources, improve coordination of treatments and services, and promote a full life in the community for people with mental illness. The Commission's recommendations will be presented in its final report. The document released this fall responds to the legal requirement for an interim report. The Commission's work is essential to the President's commitmentembodied in the New Freedom Initiativeto eliminate inequality for Americans with disabilities.
For a printed copy of the Interim Report to the President, contact SAMHSA's National Mental Health Information Center, P.O. Box 42490, Washington, DC 20015. Telephone: 1 (800) 789-2647 or 1 (866) 889-2647 (TTY). For information about the Commission and an electronic copy of the report, visit www.MentalHealthCommission.gov.
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