President's Commission Recommends Transforming Mental Health System
George W. Bush's New Freedom Commission on Mental Health issued
its final report, Achieving the Promise: Transforming Mental
Health Care in America, as part of a week-long recognition
in July of the anniversary of the Americans with Disabilities Act.
The product of a year of study, the report finds that the Nation's
mental health care system is beyond simple repair.
Building on research, expert testimony, and input from over 2,300
consumers of mental health services, family members, service providers,
and others, the report concludes that "traditional reform measures
are not enough. . . ." Instead, it recommends a wholesale transformation
that involves consumers and providers, policymakers at all levels
of government, and both the public and the private sectors.
Commission Chair Michael F. Hogan, Ph.D., Director of the Ohio
Department of Mental Health, declared, "The time has long passed
for yet another piecemeal approach to mental health reform. For
too many Americans with mental illnesses, mental health services
and supports they need are disconnected and often inadequate. The
Commission has found that the time has come for a fundamental transformation
of the Nation's approach to mental health care."
He added, "This report provides the President with a roadmap for
that transformation. The destination is recovery. We ask consumers,
family members, service providers, other members of the mental health
community, and all Americans to join us on that journey."
The Commission finds that the current system is unintentionally
focused on managing the disabilities associated with mental illness
rather than promoting recovery, and that this limited approach is
due to fragmentation in the provision of services, gaps in care,
and uneven quality of services. These systems problems frustrate
the work of many dedicated staff, and make it much harder for people
with mental illness and their families to access needed care. Instead,
the Commission recommends a focus on promoting recovery and building
resiliencethe ability to withstand stresses and life challenges.
The approach recommended by the Commission will move toward full
community participation for children and youth, adults, and older
Americans with mental illnessesinstead of school failure,
institutionalization, long-term disability, and homelessness. The
Commission presents the President with six goals and a series of
specific recommendations for Federal agencies, states, communities,
and providers nationwide. Working through both the public and private
sectors, the recommendations would achieve the needed transformation
in care and put limited resources to their best use.
Commission goals underscore the urgency and magnitude of the proposed
changes. The Commission believes that Americans must come to understand
that mental health is integral to their overall health, and recommends
that mental illnesses be addressed with the same urgency as other
medical problems. The stigma attached to mental illness, which discourages
people from seeking care, must be eliminated.
The Commission finds that transforming mental health care demands
a shift toward consumer- and family-driven services. Consumers'
needs and preferences, not bureaucratic requirements, must drive
the services they receive. To achieve that goal, the Commission
recommends changing Federal programs, upgrading state responsibility
for planning effective services, and placing consumers and their
families at the center of service decisions.
Members of minority groups and people in rural areas, the Commission
finds, have less access to care and often receive services that
are not responsive to their needs. As a result, the burden of mental
illness is heavier for these individuals. The Commission urges a
commitment to services that are "culturally competent"acceptable
to and effective for people of varied backgrounds.
The Commission's review finds that too often, mental illness is
detected late not early. As a result, services frequently focus
on living with disability, not the better outcomes associated with
effective early intervention. Therefore, the Commission recommends
a dynamic shift in care, moving toward a model that emphasizes early
intervention and disability prevention. The report notes that, "early
detection, assessment, and linkage with treatment and supports can
prevent mental health problems from compounding and poor life outcomes
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Achieving this goal will require greater engagement and education
of first-line health care providers (e.g., primary care practitioners)
and a greater focus on mental health care in institutions such as
schools, child welfare programs, and the criminal and juvenile justice
systems. The goal is integrated care that can screen, identify,
and respond to problems early. The Commission also notes that a
majority of adultseven those with the most serious mental
illnesswant to work, but they are held back by poor access
to effective job supports, incentives to remain on disability status,
and employment discrimination.
The Commission finds that effective services and supports validated
by research find their way into practice too slowly. It calls for
a more effective process to make evidence-based practices the bedrock
of service delivery. This will require that payers of mental health
care reimburse such practices, and that universities and professional
groups support training and continuing education in research-validated
interventions. Acknowledging significant progress in research on
mental illnesses, the panel urges the elimination of the 15- to
20-year lag between the discovery of effective treatments and their
wide use in routine patient care. It highlights the need for accelerated
and relevant research to promote recovery and, ultimately, to cure
and prevent mental illnesses.
The Commission recommends that the mental health system move more
effectively to harness the power of communications and computer
technology to improve access to information and care, and to improve
quality and accountability. With strong protections for privacy,
these technologies can improve care in rural areas, help prevent
medical errors, and reduce paperwork.
Throughout the report, the Commission identifies private and public
sector model programs that provide examples of how aspects of mental
health care have been transformed in selected communities.
These examples of innovationacross America, across the age
span, and addressing many needsilluminate how dramatic change
is possible, and serve as beacons for the broader improvements recommended
by the Commission.
Responding to the release of the report, U.S. Health and Human
Services (HHS) Secretary Tommy G. Thompson said, "Under the leadership
of Charles G. Curie, the Administrator of our Substance Abuse and
Mental Health Services Administration, HHS will conduct a thorough
review and assessment of the recommendations in this report. This
work will be important not only in improving our service to those
with mental illness and their families, but also as part of our
commitment to make every segment of the Nation's health care system
work better and work together for all Americans."
Mr. Curie added, "It is SAMHSA's honor to have been asked by Secretary
Thompson to undertake the Administration's first review and response
to this historic document. The report reminds us that mental illness
is a treatable illness and that recovery is possible. As a compassionate
Nation, we cannot afford to lose the opportunity to offer hope to
those people fighting for their lives to obtain and sustain recovery."
The President's New Freedom Commission on Mental Health was established
by Executive Order 13263 on April 29, 2002 (See SAMHSA News,
Volume X, Numbers 2, 3 and 4).
The Commission's work has been an essential part of the President's
commitmentembodied in the New Freedom Initiativeto eliminate
inequality for Americans with disabilities. With presentation of
the report to the President, the charge to the Commission has been
Additional information about the Commission and both its interim
report and final report are available online at www.MentalHealthCommission.gov.
Print copies of the Commission's final report can be obtained by
contacting SAMHSA's National Mental Health Information Center at
P.O. Box 42490, Washington, DC 20015. Telephone: 1 (800) 789-2647
or 1 (866) 889-2647 (TTY). Or, visit www.mentalhealth.samhsa.gov.
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