From Vision to Action

In 2002 then APA president Paul Appelbaum, M.D., appointed a task force chaired by Steve Sharfstein, M.D., to develop a statement defining the form for a genuine system of mental health care. The task force produced a splendid document, “A Vision for the Mental Health System.” It told Americans how an effective mental health system should be shaped.

The timing coincided with the work of the President’s New Freedom Commission on Mental Health, a copy of which was provided to the commission to use in its deliberations. Would the president’s commission truly describe the deplorable state of today’s mental health system? We had our answer in the letter of transmission from the commission to President Bush in which the commission declared that the mental health care system was in a “shambles” and that a “fundamental transformation” of the mental health care system was needed to restore its capacity to provide for the mental health needs of the American people.

APA’s vision statement described where we needed to go (Psychiatric News, May 16, 2003). As a follow-up to the vision report, I asked a group to work with Dr. Appelbaum and develop a roadmap to guide decision makers in transforming the vision into a reality. The Ad Hoc Work Group to Actuate the Vision presented its work to the acclaim of the Board of Trustees in March (Psychiatric News, April 2).

The work group report identifies seven themes derived from the vision statement’s principles as a guide for the implementation:

•.	Creation of an effective system for delivering mental health care Integrating general health and mental health care Providing for the special needs of persons with more severe mental disorders Reaching out to underserved areas and groups
•.	Provision of appropriate coverage Creating universal and nondiscriminatory coverage for mental health treatment Offering adequate reimbursement for mental health treatment
•.	Development of an adequate workforce to meet the country’s mental health services needs
•.	Moving toward a patient-centered, culturally competent mental health care system
•.	Reducing the stigma of mental disorders
•.	Improving the quality of mental health care
•.	Promoting research on mental disorders

For each theme, the report provides objectives to accomplish the goal and strategies to bring each objective to fruition.

For example, take the first theme:

1.1 Creation of an effective system for delivering mental health care

1.1.1 Develop a model of care and guidelines for funding based on the core principles of the Community Mental Health Act of 1963, including a nationwide system of catchment areas, each of which contains an entity with responsibility for all persons with serious and persistent mental disorder. Finance this system by means of an integrated stream of federal, state, county, and insurance funding. Promote this model as the best long-term solution to the needs of the population with serious and persistent mental disorders throughout the country.

  1.1.1.1 Identify and promote appropriate roles for psychiatrists in community-based systems, highlighting their value as team leaders and emphasizing the counterproductive effects of limiting their involvement to medication evaluation and prescription. Full integration of treatment for substance use disorders and other psychiatric services, regardless of venue, for all programs, including primary care settings as appropriate.

1.1.2 Expand this model to address treatment occurring in the private sector and encourage flexible financing for the full range of services available to meet the needs of patients.

1.1.3 Develop a complementary model for the integration of psychiatric and other medical services in organized settings of care, based on the principle that many psychiatric disorders can be treated by primary care physicians who have adequate training and ready availability of psychiatric consultation—and that a sufficient number of psychiatrists is not likely to be available in the foreseeable future to care for all persons with psychiatric disorders.

I’ve quoted only a few of the recommendations laid out by the work group to give you a sense of the direction and quality of the work product. Dr. Appelbaum and his dedicated work group have given us a compass and the motive power to implement our vision for a regenerated mental health system that will be responsive to our national needs. The work group’s product is also a work in progress, as are all of our advocacy agendas, to be reshaped according to the exigencies of our time. The statement has been sent to all of APA’s councils, committees, and other components; the Assembly; and other colleagues who have made contributions. If you are interested in joining in on a review of this process, let me know at [email protected]. ▪