Marking a milestone in the history of mental health
and mental illness in America, SAMHSA recently released
Mental Health Care in America—The Federal Action
Agenda: First Steps.
"As we mark the 15th anniversary of the Americans
with Disabilities Act, the Action Agenda makes an important
contribution for Americans with mental health-related
disabilities," said Mike Leavitt, U.S. Secretary
of Health and Human Services (HHS).
"The Action Agenda details the initial steps the
Federal Government is taking to transform the form and
function of the mental health service delivery system
in America," said Secretary Leavitt. "HHS
and its partners across the Federal Government are committed
to a shared goal of collaborating to change fundamentally
the way the Nation's mental health care system
SAMHSA led the Action Agenda's development. The Agency
aligned six cabinet-level departments—Education,
Health and Human Services, Housing and Urban Development,
Justice, Labor, Veterans Affairs, and the Social Security
Administration—in an unprecedented multi-year effort,
which includes more than 20 Federal agencies to carry
out the 70 specific steps of the Action Agenda.
In addition, a Federal Executive Steering Committee
was announced to guide the work of mental health system
The Action Agenda represents the very first "to do"
list in the Federal response to Executive Order 13263,
which launched President Bush's New Freedom Commission
on Mental Health in 2002. The Commission's final
report, Achieving the Promise: Transforming Mental
Health Care in America, released in July 2003, found
the Nation's mental health system "fragmented and
in disarray." In that report, the Commission called for
a complete transformation of the mental health service
SAMHSA News, Volume 11, Number 3.)
The Action Agenda builds on the Commission's recommendations
with a clear plan to redirect the mental health system
to its primary goal: To help adults with serious mental
illnesses and children with serious emotional disturbances
achieve recovery—to be able to live, work, learn,
and participate fully in their communities.
"The Action Agenda is a living document that begins
to chart the course for long-term change," said
SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W.
"It is not a ‘quick fix' for the problems
that have ailed the mental health care system for decades."
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Recovery Is Key
The foundation of the Action Agenda rests on the principle
that recovery from mental illness is the expectation,
not the exception.
"We are counting on consumers and family members
to play a meaningful role," said SAMHSA's
Center for Mental Health Services Director A. Kathryn
Power, M.Ed. "In a transformed mental health system,
services and treatments are consumer- and family-centered.
Furthermore, care must focus on increasing an individual's
ability to cope successfully with life's challenges,
on building resilience—not just on managing symptoms—and
on facilitating recovery."
The New Freedom Commission's final report offered
good news: Adults with serious mental illnesses and children
with serious emotional disturbances can and do recover.
But Ms. Power continued, "Success means a system
grounded in recovery and resilience, one that demonstrates
a commitment to providing recovery-based services, and
one that—through its actions—inspires hope
for families and consumers alike."
Yet across the United States, many people with mental
illness remain untreated. They struggle with an illness
that affects their minds, their feelings, and their relationships
with others. Approximately 19.6 million adults age 18
or older (9.2 percent) in the United States have a serious
mental illness, according to SAMHSA's National
Survey on Drug Use and Health. A similar percentage of
children, about 5 percent to 9 percent, have a serious
mental health problem.
"The reason for the Action Agenda is simple,"
Mr. Curie continued. "People with mental disorders
have a vital role to play. Their ability to participate
fully can no longer be derailed by outdated science,
outmoded financing systems, and unspoken discrimination.
Putting people with mental disorders at the heart of
the health care system can be accomplished through the
steps outlined in this Action Agenda," he said.
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The Action Agenda presents the transformation process
in four parts: principles, success markers, action steps,
and current Federal activities. This simple format provides
all the information required to follow the Federal Government's
plan for mental health system transformation.
The Action Agenda is organized around the five Principles
set forth in the President's 2002 Executive Order establishing
Principle A: Focus on the outcomes
of mental health care, including employment, self-care,
interpersonal relationships, and community participation.
Principle B: Focus on community-level
models of care that coordinate multiple mental health
and human service providers and private and public payers.
Principle C: Maximize existing resources
by increasing cost-effectiveness and reducing unnecessary
and burdensome regulatory barriers.
Principle D: Use mental health research
findings to influence the delivery of services.
Principle E: Ensure innovation, flexibility,
and accountability at all levels of government and respect
the constitutional role of the states and Indian tribes.
A "State of Success" follows each Principle
with a list of specific achievements that, as they are
accomplished, will herald a transformed mental health
Action steps for each Principle will
move the mental health service system toward transformation.
Current activities in progress for
each Principle are included in the Action Agenda. SAMHSA
has completed an inventory of current, relevant Federal
activities that respond to the Commission's vision.
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Action Agenda Components
The Action Agenda presents a simple plan to carry out
the "to do" list-the five Principles
set forth in Executive Order 13263, which established
the President's New Freedom Commission on Mental Health
in 2002. The following diagram illustrates the components
of the Action Agenda:
Each Principle represents a specific
task. To complete that task or Principle, detailed Action
Steps are outlined for specific Government agencies
and Current Activities under way are
compiled. These efforts contribute to a State
of Success and a transformed mental health system.
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Doing the Work
The public sector is the major financial driver in mental
health care. Transformation is, however, "a shared
responsibility," according to Mr. Curie. Federal
agencies can act as leaders and as facilitators, promoting
shared responsibility for change at the Federal, state,
and local levels, and in the private sector, in such
areas as public education, research, service system capacity,
and technology development.
States, however, will be the very center of system transformation.
Many states have already begun this critical work. Their
leadership in planning, financing, service delivery,
and evaluation of consumer and family-driven services
will significantly advance mental health transformation.
SAMHSA's Mental Health Transformation State Incentive
Grants are a key component of mental health system transformation.
This grant program is unique in taking a "big picture"
approach to improving service delivery. The focus is
on state infrastructure—what a state puts into
place to coordinate mental health planning, financing,
services, and evaluations conducted by multiple systems
to facilitate recovery and promote resilience for individuals
and families coping with mental illnesses.
The grants provide seed money for the states to use
to make systemic changes based on each state's
vision of a comprehensive mental health system. SAMHSA
has awarded grants totaling nearly $19 million to Ohio,
Oklahoma, Washington, Maryland, New Mexico, and Texas.
A new Web page of state activities is now available,
sponsored by SAMHSA through the National Association
of State Mental Health Program Directors (NASMHPD). (See
Web Resources in Part 2 of this article.)
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Action Agenda Highlights
Reinforce the message that mental illnesses
and emotional disturbances are treatable and that recovery
is the expectation.
Act immediately to reduce the number of suicides
in the Nation through implementation of the National
Strategy for Suicide Prevention, launched by the U.S.
Department of Health and Human Services in 2001.
Help states develop the infrastructure necessary
to formulate and activate comprehensive state mental
health plans that include the capacity to create individualized
plans of care that promote resilience and recovery.
Develop a plan to promote a mental health workforce
better qualified to practice mental health care that
is culturally sensitive and based on evidence-based practices
in both specialty settings and at the primary care level.
Initiate a national effort focused on the mental
health needs of children and promote early intervention
with informed parental consent for children identified
to be at risk for mental disorders. Prevention and early
intervention can help forestall or prevent disease and
Improve the interface of primary care and mental
Expand the Science-to-Services agenda to develop
new toolkits outlining evidence-based practices for use
by providers, administrators, educators, and consumers.
Increase the employment of people with psychiatric
Design and initiate an electronic health records
and information system that will help providers and consumers
better manage mental health care and that will protect
the privacy and confidentiality of each consumer's
Also-Article Continued: Part 2 »
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