12 Principles to Guide MH System Reform

The following principles appear in “A Vision for the Mental Health System,” which APA released last month:

• Every American with psychiatric symptoms has the right to a comprehensive evaluation and accurate diagnosis that leads to an appropriate, individualized plan of treatment.

• Mental health care should be patient and family centered, community based, culturally sensitive, and easily accessible without discriminatory administrative or financial barriers or obstacles.

• Mental health care should be readily available for patients of all ages, with particular attention to the specialized needs of children, adolescents, and the elderly. Unmet needs of ethnic and racial minorities require urgent attention.

• Access to mental health care should be provided across numerous settings, including the workplace, schools, and correctional facilities. An emphasis should also be placed on the early recognition and treatment of mental illness.

• Patients deserve to be treated with dignity and respect. When they are clinically able, they are entitled to choose their physician or community-based agency and to make decisions regarding their care.

• Patients deserve to receive care in the least-restrictive setting possible that encourages maximum independence with access to a full continuum of clinical services, including emergency/crisis, acute inpatient, outpatient, intermediate-level, and long-term residential programs.

• Since mental illness and substance abuse occur together so frequently, mental health care should be fully integrated with the treatment of substance abuse disorders and with primary care and other general medical services.

• Support must expand for research into the etiology and prevention of mental illness and into the ongoing development of safe and effective treatment interventions.

• Efforts must be intensified to combat and overcome the stigma historically associated with mental illness through enhanced public understanding and awareness.

• Health benefits, access to effective services, and utilization management must be the same for people with mental illness as for other medical illnesses, preferably funded by integrated financing systems. Although states are the ultimate locus of responsibility for the public safety net, the federal government and the private sector employers must also support an increased investment in the mental health of Americans.

• Funding for care should be commensurate with the level of disability caused by psychiatric illness. Disability occurs both in the severely and persistently mentally ill and in patients with other unforeseen psychiatric conditions who suffer despite having been productive and functional.

• More resources should be devoted to treatment and to training an adequate supply of psychiatrists, especially child psychiatrists, to meet the current and future needs of the population.

APA’s “A Vision for the Mental Health System” is posted on the Web at www.psych.org/news_stand/visionreport040303.pdf.