Report Calls for Overhaul Of Crippled MH System

The New Freedom Commission on Mental Health recommended a “fundamental transformation of the nation’s approach to mental health care” in the letter transmitting its final report to President Bush on July 22.

Bush, who established the commission on April 29, 2002, asked its members to recommend improvements in the U.S. mental health system for adults with serious mental illnesses and for children with serious emotional disturbances (Psychiatric News, May 17, 2002).

He requested a review of both the public and private sectors to identify policies that could be implemented by federal, state, and local governments to maximize the usefulness of existing resources, improve coordination of treatments and services, and promote a full life for people with mental illness.

Commission chair Michael F. Hogan, Ph.D., characterized the mental health care system as a “patchwork relic—the result of disjointed reforms and policies” in his July 22 letter.

He told the Washington Post, “We have an unintended conspiracy to keep people disabled” (July 23).

The report amplifies on the commission’s initial findings in its interim report in November 2002. At that time, members said, “Something is terribly wrong, terribly amiss, with the mental health system” (Psychiatric News, December 6, 2002).

Commission members were “united in the belief that the mental health service delivery system needs dramatic reform.”

The final report emphasizes the possibility of recovery, which it defines as “the process by which people are able to live, work, learn, and participate fully in their communities.”

Commission members recommended that consumers and their families play a larger role in managing the funding for their services, treatments, and supports.

By allowing funding to follow consumers, incentives will shift toward a system of learning self-monitoring and accountability, they wrote.

APA President Marcia Goin, M.D., told Psychiatric News, “Anyone affected by the quality of mental health services—and that’s everyone in the country—should gain hope from this report. It’s extremely encouraging that such a comprehensive and honest acknowledgement of the problems of the mental health system is possible in this period of shrinking resources for health and social programs.”

She said that the report could serve as a springboard for action on important issues such as parity.

The commission “strongly” supported federal legislation to provide full parity between insurance coverage for mental health care and for other kinds of care.

Goin was the only mental health advocate quoted in the New York Times (July 23) about the report to call attention to the importance of adequate funding.

She said, “The reality is that there needs to be a big structural change. And you can’t do that without funding.”

In her press statement of July 22, Goin wrote about the problems of discriminatory funding policies in Medicare for mental health care, deep cuts in state Medicaid programs, and wide disparities in coverage by private insurance companies.

She reiterated her concerns in an interview with Psychiatric News, saying, “It’s impossible to determine a method of correcting problems in the mental health system that would not require additional funding.”

Last November, when the commission issued its interim report, then APA president Paul Appelbaum, M.D., said that the New Freedom Commission had “unreasonably limited” its examination of problems with the mental health system by focusing exclusively on budget-neutral solutions.

Advocates Respond

The report has generated support from a broad range of mental health advocates and publicity in major newspapers. However, advocate after advocate, including the commission’s chair, warned about the need for action to implement the recommendations.

Hogan told the Washington Post (July 23), “A road map is only good if you follow it.”

Richard Birkel, executive director of the National Alliance for the Mentally Ill, said, “We do not want another presidential commission, surgeon general’s report, state audit, or newspaper expose telling us what we already know too well. Let today be the turning point.”

Robert Bernstein, executive director of the Bazelon Center for Mental Health Law, said, “Policymakers have a choice—they can put this report on the shelf and continue the past policies of hopelessness, or they can act on its recommendations. . . .”

Michael Faenza, president and CEO of the National Mental Health Association, said, “The commission’s report is a prescription meant to fix a mental health ‘system’ that is on the verge of plunging from crisis to catastrophe. . . .But without commitment, action, and funding, this report is worth no more than the paper it is written on.”

Next Steps Outlined

Goin told Psychiatric News that APA is implementing two major strategies to capitalize on the report’s recommendations and current public attention to mental health issues.

She created the Ad Hoc Committee to Actuate the Vision Statement to recommend actions that APA can undertake to realize the 12 principles and other ideas outlined in its document, “A Vision for the Mental Health System.”

In April the Board of Trustees approved the “vision statement,” which had been developed by a committee chaired by APA Vice President Steven Sharfstein, M.D. (Psychiatric News, May 16). The committee was responding to the need for a descriptive model of a well-functioning mental health system developed by psychiatrists in accordance with core values of the profession.

Former APA President Paul Appelbaum, M.D., chairs the ad hoc committee. The other members are Carl Bell, M.D., Mary Helen Davis, M.D., Prakash Desai, M.D., Anita Everett, M.D., Rohan Ganguli, M.D., David Mrazek, M.D., Steven Sharfstein, M.D., Ann Sullivan, M.D., and Kenneth Wells, M.D.

APA’s Division of Government Relations is working with the Campaign for Mental Health Reform, a coalition of mental health advocacy organizations and medical specialty associations that was formed to encourage implementation of recommendations in the report and other reforms of the mental health system.

Coalition members include the National Alliance for the Mentally Ill, National Mental Health Association, National Association of State Mental Health Program Directors, as well as associations such as the Federation of Families for Children’s Mental Health and the Depression and Bipolar Support Alliance.

The final report of the New Freedom Commission on Mental Health and related documents are posted on the Web at www.mentalhealthcommission.gov. Updates on the work of the Campaign for Mental Health Reform are posted at www.nmha.org. APA’s “Vision for the Mental Health System” is posted on APA’s Web site at www.psych.org/news_stand/visionreport040303.pdf. ▪