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President's New Freedom
Commission on Mental Health

 

Meeting Minutes
April 3, 2003

Westin Embassy Row
Washington, D.C.

The President's New Freedom Commission on Mental Health met on April 3, 2003 at the Westin Embassy Row, 2100 Massachusetts Avenue in Washington, D.C. In accordance with the provisions of Public Law 92-463, the meeting was open to the public from 8:40 a.m. to 12:10 p.m.

Commissioners present:

Michael F. Hogan, Chair
Jane Adams
Rodolfo Arredondo, Jr.
Patricia Carlile
Charles G. Curie
Daniel B. Fisher
Anil G. Godbole
Henry T. Harbin
Larke N. Huang
Gail P. Hutchings
Thomas R. Insel
Norwood W. Knight-Richardson
Ginger Lerner-Wren
Stephen W. Mayberg
Joan Mele-McCarthy
Frances M. Murphy
Richard Nakamura
Robert N. Postlethwait
Waltraud E. Prechter
Chris Spear
Nancy C. Speck
Deanna Yates


Staff members present:

Claire Heffernan, Executive Director
H. Stanley Eichenauer, Deputy Executive Director
Dawn Foti Levinson
Ann Jacob Smith
Patty DiToto
Elaine Viccora

March 5, 2003


Work Session

Chairman Hogan opened the Commission's final public meeting at 8:40 a.m. The Commission's initial action was to consider the meeting minutes from the previous meeting.

Approval of March Minutes

Chair Hogan requested that the Commissioners review and approve the minutes from the March 2003 meeting. Commissioner Knight-Richardson moved that the Commission approve the draft minutes. Commissioner Lerner-Wren seconded the motion. Commissioners voted unanimously to approve the draft.

Noting that all of the Commissioners reached out to various members of the mental health community, Commissioner Huang discussed her recent meeting with Christy, a young artist from Arkansas who has bipolar disorder. As part of a public awareness campaign in her state, Christy designed a flag to promote mental health. The flag then was selected to fly over her state capitol building. Christy's goal is to fly this flag over every state capitol to raise awareness about mental health. The National Lieutenant Governor's Association recently invited Christy and her family to Washington, D.C., where the flag was flown over the nation's Capitol Building. Christy and her family are excited about the Commission's work and have volunteered to help communicate the Commission's mission as they travel throughout the country.

Chair Hogan then launched the Commission's discussion about its final report. He reviewed a draft outline for the final report, which contained a vision statement, six goals, and relevant recommendations.

Proposed Vision Statement

We are committed to a future where recovery is the expected outcome and when mental illness can be prevented or cured. We envision a nation where everyone with a mental illness will have access to early detection and the effective treatment and supports essential to live, work, learn and participate fully in their community.

Commissioner Mayberg commented that the vision statement accurately reflected the Commission's aspirations and should serve as a measure to assess the nation's progress.

Commissioner Fisher was pleased with the vision statement, particularly the positive emphasis on recovery. Given the word "committed" has additional meanings, he asked that the Commission consider an alternate word.

Chair Hogan suggested using the word "hope."

Commissioner Curie highlighted that recovery was the basic tenet for the Commission's discussions during the past year. In addition, recovery is a principle that is consistent with the Executive Order. Recovery is not simply something for which to hope; recovery should be expected now - in the immediate future.

Commissioner Godbole noted that the outline reflected key elements also present in the Surgeon General's report, Institute of Medicine's report, and the President's Executive Order.

Commissioner Harbin requested a more action-oriented word be used, such as "dedicated." He commented that the vision statement communicates that the Commission can envision a future where science can help cure some of the major mental illnesses - a critical long-term goal.

Alternate Commissioner Nakamura stated that this vision statement reflected the winds of change and a future where consumers and providers act in partnership and treatments are based upon evidence. He added that the current system is not yet structured to facilitate recovery for many individuals.

Chair Hogan expressed pride in fellow Commissioners and their ability to weave together many of the ideas discussed. He also discussed Mrs. Carter's visit with the Commission and her comment about how the possibility of recovery did not even exist during the Carter Commission's tenure. This comment helped to build a framework for the current Commission's discussions.

While not opposed to the word "recovery," Commissioner Adams requested that the vision statement use the term "across the lifespan" to address the needs and hopes of children and families. She also would prefer the phrase "mental health" rather than mental illness and suggested the language, "where everyone has access to mental health through early detectionů"

Commissioner Curie also asked that the vision statement reflect the needs of children with serious emotional disturbance.

Noting that the Commission's guiding principles addressed healthy development and resiliency, Chair Hogan suggested elevating those principles to the vision statement.

Commissioner Knight-Richardson moved to accept the vision statement along with the Commissioners' subsequent comments. Commissioner Postlethwait seconded the motion. Commissioners voted unanimously to accept the draft vision statement for the final report.

Goal 1 - Mental Health is Essential to Health

Every individual, family and community will understand that mental health is an essential part of overall health.

· Everyone takes action to ensure well-being
· Mental health awareness

Recommendations:

· Advancement and implementation of national strategies for suicide prevention and national campaign to reduce the stigma of seeking care.
· Align federal policies with mental health system goals

Commissioner Curie emphasized that transformation of the mental health system must begin with the knowledge that mental health is a part of overall health. Stigma is a specific barrier to achieving that widespread awareness. He also commented that given its importance, it was appropriate to list Goal 1 first.

Commissioner Knight-Richardson responded that the order of the goals had not yet been determined; Commissioner Curie agreed.

Commissioner Lerner-Wren suggested that the awareness goal should be the first goal in the final report. As evidenced by the public testimony and Commissioners' experiences in the community, the mental health field needs to change attitudes through public education. She noted that one of the most moving panels before the Commission was the Atlanta businessmen who spoke of their own experiences with depression. She urged the creation of public and private partnerships to develop public education campaigns.

Commissioner Postlethwait commented that achievement of this goal would be the realization of his personal dream. The vision's description of such a positive and hopeful future state represents real progress.

Commissioner Huang noted that public and private education campaigns currently exist; the challenge is to build upon them and reach rural and minority populations.

Chair Hogan agreed that this goal was both a future-oriented goal and an ongoing goal that is moving now, as evidenced by NIMH's current awareness campaign on men and depression.

Commissioner Godbole expressed support for keeping this goal first, given the importance of communicating the message that mental health is a component of overall health. This goal is a call for action for the entire system. Regardless of the type of campaign developed, the right messages should be delivered to each constituency.

Commissioner-Knight Richardson underscored that the goal's language ("we") encompasses diverse populations. Culturally relevant programs are needed to reach diverse populations (e.g., Native Americans, Hispanics, African Americans, etc.).

Commissioner Harbin also thought it was a very good first goal, particularly given the lack of understanding about mental illness and lack of awareness about available, effective treatments. While noting that the proposed financing recommendations appear later in the document, he suggested incorporating the issue of parity into this discussion, perhaps as a principle. He urged the Commission to make a clear statement supporting the President's backing of a private insurance parity bill. Commissioner Harbin added that parity is necessary to achieve the goals proposed by the Commission.

Chair Hogan indicated that the Commissioners' previous conversations expressed support for the parity concept; thus the report should include a reference to parity.

Commissioner Curie suggested that the Commission include a recommendation that each institute within the National Institutes of Health (NIH) demonstrate a focus on the mental health aspects of the diseases it studies. Such a recommendation would strengthen the goal that mental health is a critical part of overall health.

Commissioner Godbole agreed with the proposal, reporting that the IOM is overseeing two major initiatives on mental health. Mental health must be embedded in all health-related discussions and activities.

Chair Hogan commented that members appeared to agree with this proposal.

Commissioner Fisher indicated that the statement referencing stigma was too narrow. Stigma and discrimination affect all aspects of community integration-including living, working, learning and participating in the community. The Commission would be remiss to focus only on the aspects of stigma that interfere with seeking care. Stigma is such a big issue, it may require two separate recommendations.

Chair Hogan said that he agreed with Commissioner Harbin's sentiments about stigma; however, the Commission has been encouraged to not create a lengthy and detailed list of recommendations. The Commission's current recommendation about a public campaign was informed by research shared by Dr. Patrick Corrigan and others. There is some evidence that indicates media-based campaigns may encourage help-seeking behaviors. However, media-based campaigns have not been shown to be effective to change behaviors or beliefs. As Dr. Corrigan noted, such attitudes and behaviors typically change as a result of personal contact. Chair Hogan added that the Substance Abuse Mental Health Services Administration's Eliminating Barriers Initiative includes a number of different strategies to address barriers.

Commissioner Fisher agreed that personal contact does help overcome stigma. However, the Commission should encourage further work in this area, particularly as one of the primary concerns of people with mental illness is continuing segregation. The Commission should pursue an overall approach with different strategies.

Commissioner Speck moved that the Commission accept Goal 1 along with the subsequent discussion. Commissioner Harbin seconded the motion.

Alternate Commissioner Nakamura stated that he and his colleagues would have to review the new recommendation related to NIH to ensure it could be implemented within the NIH system. With that caveat, he could consider the motion. Chair Hogan agreed that such a review was implicit and that Commissioners would accept that understanding.

Commissioner Adams asked to add the words, "and the promise of life in the community" to the current phrase "mental health is an essential part of overall health." She added that most families do not even know what mental health means, much less the services that should be provided. As families attempt to navigate and access the various child-serving systems, they also risk losing custody of their children.

Commissioner Curie stated a multi-faced approach is needed to address stigma and barriers, which should be captured in the recommendations.

Commissioners voted unanimously to accept Goal 1, its recommendations, and the accompanying discussion.

Goal 2 - Early Mental Health Screening and Treatment in Multiple Settings

Every individual will have the opportunity for early and appropriate mental health screening, assessment, and referral to treatment.

Recommendations:

· Strengthen early childhood mental health interventions: Implement a national effort to focus on mental health needs of young children and their families that includes screening, assessment, intervention, training, financing of services.
· Screening, assessment and treatment for co-occurring disorders will be the expectation in mental health, substance abuse, child welfare, criminal and juvenile justice and primary care settings.
· Screening for mental disorders in primary care settings across the life span. Collaborative care models for identification and treatment of mental disorders across the lifespan should be widely implemented in primary care settings and reimbursed by public and private insurers.
· Building on "No Child Left Behind Act" and the reauthorization of Individuals with Disabilities Education Act (IDEA), improve and expand mental health programs in schools to ensure that youth with emotional and behavioral disorders succeed and graduate from school.

Commissioner Arredondo clarified that the recommendation on co-occurring disorders does not require clinicians in primary care (or other settings) to conduct full assessments, just screen and refer. He requested that the word "refer" be added.

Commissioner Lerner-Wren observed that the set of recommendations does not address effectiveness or outcomes.

Chair Hogan suggested effectiveness is addressed under Goal 4. He added that Commission has identified particular settings where evidence is clear that screening, assessment, referral and treatment are appropriate.

Alternate Commissioner Nakamura stressed the importance of the word "early" as serious mental illnesses have recognizable signs. Diagnosis and treatment often occurs years after the first presentation of symptoms. Given it is more difficult to treat people once they have lived with symptoms for decades, early intervention is a more effective alternative.

Chair Hogan noted that the President requested that the Commission focus on children with serious emotional disturbance and adults with serious mental illness; however, those disorders can start earlier.

Alternate Commissioner Mele-McCarthy requested that the word "identification" be incorporated into the "No Child Left Behind" recommendation and include the babies and toddlers covered by IDEA's Part C. In addition, given the poor graduation rates of students with serious emotional disturbance, she asked the Commission to promote innovative educational options for students so they can have better post-school outcomes.

Chair Hogan observed that references to student outcomes (e.g., graduation rates) strengthen this recommendation.

Commissioner Godbole discussed the need to standardize screening and early detection instruments. He requested that the Commission reinforce the need for effective, meaningful, cost-effective, and standardized screening.

Commissioner Harbin made a motion to accept Goal 2, which was seconded.

Commissioner Huang was pleased that Commissioners were supportive of this goal and recommendations. She also wanted the final report to include screening in the juvenile justice system, perhaps within this section or another goal.

Commissioner Godbole wondered if the recommendations could include screening in nursing homes, too. Chair Hogan noted that such a requirement already exists in statute.

The Commission voted to accept Goal 2, recommendations, and relevant discussion.

Goal 3 - Consumer/Family Centered Care

Consumers and families will have the necessary information and the opportunity to exercise choice over the care decisions that affect them.

· Continuous healing relationships will be a key feature of care.

Recommendations:

· States should ensure that each adult with serious mental illness (SMI) and each child with serious emotional disturbance (SED) and his or her family have a single, individualized plan of care.
· Create an integrated state plan for treatment and support
· Expanding the recovery orientation of the system of care by increasing the opportunities and capacities of consumers to share their inspiration, knowledge, and skills.
· Strengthen and expand supported employment
· Protect and enhance rights
· Medicaid/Medicare/financing reform that includes references to parity, home/community based services, and IMD reform.
· Improve access to housing and end chronic homelessness

Alternate Commissioner Nakamura stated his belief that this emphasis on system centering on consumers and families was critical for reducing fragmentation. By articulating this goal, the Commission is encouraging systems to reorganize around individuals.

Chair Hogan discussed the call for an Integrated State Mental Health Plan. He noted that the current state mental health planning process was inadequate, particularly as it evolved before the development of multiple funding sources for treatment and supports (e.g., Medicaid, juvenile justice, vocational rehabilitation). He reminded the Commission that staff had identified 40 different federal programs that fund mental health services or supports. The unintended consequence of these multiple streams is a confusing maze for consumers and families. Establishing a more comprehensive state plan would reduce the confusion, as well as provide more flexibility and accountability.

Commissioner Fisher commented that the activities listed under Goal 2 (e.g., screening and assessment) should be performed with Goal 3 in mind. He suggested that Goal 3 might be appear earlier in the final report, as it is an overarching goal that should affect all levels of care. He also stressed that the recommendation on individual plans should indicate that the plans are developed based upon the goals of the individual. Finally, he agreed that placing the financing recommendation under Goal 3 was appropriate as promoting more choice through financing mechanisms (e.g., vouchers) would provide consumers control over resources.

Alternate Commissioner Mele-McCarthy asked that the Commission to consider inserting "supported education" into the supported employment recommendation.

Commissioner Carlile observed that financing is the backbone for sustaining future activities. The Commission may want to consider adding "and innovations" to the financing reform recommendation since additional financing strategies will be identified in the future.

Chair Hogan agreed with the goal of moving toward more consumer and family control over resources; however, he noted that how such movement occurs within complicated federal programs would require a great deal of additional discussion.

Commissioner Adams urged that the recommendation include references to supporting families with information, in addition to "increasing the opportunities and capacities of consumers." Families must have similar support; perhaps that concept was just omitted. She also asked that the "protect and enhance rights" recommendation address the issue of custody and the need to protect families from losing their children.

Chair Hogan agreed that Commission intended to express strong support for families and address the custody issue within the report, although it had not been determined in which section the custody discussion would occur.

Commissioner Curie underscored the importance of Goal 3 and its potential to transform the system and create a seamless system for consumers and their families.

Commissioner Harbin noted that the Commission proposed several specific financing recommendations aimed at providing more flexibility to the current reimbursement systems. He cautioned against moving too quickly in multiple, untested directions (e.g., vouchers). For example, the private insurance industry is examining consumer-directed health care; however, the industry had not implemented the model for people with serious disabilities. Commissioner Harbin indicated that financing strategies must be studied further. Meanwhile, he did not want to lose momentum with some of the positive, reimbursement-related changes proposed by the Commission.

Chair Hogan added that CMS is exercising leadership and providing states with clarification about how to appropriately provide Medicaid reimbursement for evidence-based practices.

Commissioner Huang requested that the first recommendation reflect the concept of partnerships between consumer, family and providers. She also stated that the report needed a recommendation that directly addressed the prevention of custody relinquishment, perhaps under the financing reform or rights section.

Commissioner Lerner-Wren asked that the discussion about the juvenile justice system be added to the current criminal justice recommendation. She also noted previous Commission discussions about CMS providing clarification to states about Medicaid eligibility and disenrollment rules for incarcerated individuals, which was not explicit in the current outline.

Commissioner Godbole moved to accept Goal 3, a motion seconded by Commissioner Speck. The Commission voted unanimously to accept Goal 3, the recommendations, and the relevant discussion.

Goal 4 - Best Care Science Can Offer

Adults with serious mental illness and children with serious emotional disturbance will have ready access to the best treatments, services, and supports leading to recovery and cure. Accelerate research to enhance prevention of, recovery from and the ultimate discovery of cures for mental illnesses.

Recommendations:

· Accelerate research to cure or prevent mental illness. Continue research to improve mental health outcomes and support recovery.
· Expand the knowledge base to inform policy designed to reduce mental heath disparities, long-term effects of medications, and develop process to study crisis interventions and acute care.
· Evidence-based practice interventions should be tested in demonstration projects with oversight by a public-private consortium of all stakeholders. The results of those demonstrations should form the basis for directing support of financing, dissemination and workforce development.
· Increase and improve a diverse mental health workforce across the country, through public-private partnerships based on multidisciplinary training models.

Commissioner Insel expressed concern that the title of this goal did not reflect that new science would be available in the future. He asked that the language preserve the sense of discovery, as well as delivery, of science-based treatment.

Chair Hogan echoed his agreement, asking that the wording be changed to suggest a more dynamic goal.

Agreeing the goal's title should be modified, Commissioner Godbole clarified that the aim of the goal was to encourage the best care that could be offered by providers, program, and systems, as well as science.

Chair Hogan noted that the final report should reflect the richness of Commission's conversations, including the following points: (1) As science improves, there will be better emerging best practices that are not currently available; and (2) This improving science should be the basis for the delivery of care. The final report needs to reflect more the richness of the Commission's conversation.

Commissioner Harbin observed that Goal 4 was powerful as it indicated that people with serious mental illness would have access to science-based treatment. He also suggested that the Commission identify those community-based models that could and should be disseminated more widely. He commented that if adults and children with serious mental illnesses were to have access to model programs, the programs must be more widely available.

Chair Hogan agreed with the concept, but clarified that the recommendation should not suggest that every person must be able to access every model service.

Commissioner Fisher observed that science's current focus on single variables might be too narrow to explore some of the complexities of mental illnesses. He underscored the importance of providing financial support for a broader research agenda, which includes the multiple dimensions of recovery.

Commissioner Insel commented that today's science is largely based upon large-scale, double-bind trials and does not capture individual variation. Ultimately, the field will need a science that will encompass a broader agenda, perhaps the focus for a future Commission.

Commissioner Adams requested that the last recommendation on work force development be expanded. Currently, the recommendation appears buried at the bottom of the recommendations; however, maintaining and supporting the work force have been major topics discussed by the Commission. She also commented that the recommendation is aimed at helping providers be better able to deliver effective services.

Chair Hogan asked for a motion to adopt Goal 4 with the discussed changes to the goal and recommendations. A motion was made, seconded, and the Commission voted unanimously to adopt Goal 4.

Goal 5 - Information Infrastructure

The mental health system will develop and expand its information infrastructure. That infrastructure has many purposes:

· Inform consumers, providers and public policy
· Improve access, quality, accountability

Recommendations:

· Use information technology to improve care.
· Inform policy by expanding the knowledge base

Commissioner Lerner-Wren addressed the first bullet under the goal, commenting that the goal should inform a broader audience, including the general public and education field.

Expressing support for this goal, Commissioner Huang commented that technology should be used to both develop an information infrastructure and also deliver care. She recommended that the goal title be expanded to reflect both of those elements.

Commissioner Speck also stated her strong support for this goal. She suggested that the language might be rewritten to highlight the Commission's promotion of "technology infrastructure" for use in service delivery, as well as information storage and dissemination. Such an infrastructure is critical to deliver care, provide training on evidence-based practices, and provide equal access to information.

Alternate Commissioner Mele-McCarthy asked that the final report mention the importance of using technology that incorporates universal design so people with disabilities (e.g., sensory, perception, mobility) also have access to this technology.

Commissioner Insel referenced the Veteran Administration's IT program, which created a national database for the VA and helped with both delivery of care and research. He asked if this goal should be expanded and proposed that the technology infrastructure inform policy and research questions, as well.

Commissioner Speck noted that when a system develops its information infrastructure, many opportunities for research arise.

Commissioner Fisher requested that the need for confidentiality be highlighted within this goal. Commenting that the word "information" was uninspiring, he suggested using a more interactive and dynamic word, such as "communication." He also gave examples of how consumers have used technology effectively with peers, including warm lines and the Internet.

Referencing the privacy concerns, Chair Hogan noted that the Commission will recommend that the federal government take the lead in protecting rights and privacy by addressing the types of questions related to mental illness posed to federal applicants.

Commissioner Adams requested an additional recommendation that discussed the importance of training end-users on how to use technology systems. She commented that such training is as critical as the data contained in the system.

Commissioner Harbin observed that a number of the technology recommendations would not be extremely costly to implement, particularly as some ideas were already on line.

Commissioner Curie indicated that the Commission's goals are achievable only if the technology infrastructure is developed. Technology is essential to the transformation of mental health care, yet the mental health field is behind in developing this infrastructure.

Commissioner Insel reinforced the point made by Commissioner Fisher: Communication should be the focus of this goal.

Commissioner Godbole made a motion to accept Goal 5 with the accompanying discussion. Commissioner Speck seconded the motion. The Commission approved the motion unanimously.

Goal 6 - Eliminate disparities in mental healthcare

Promote well-being for all people regardless of race, ethnicity, language, place of residence, or age and ensure equity of access, delivery of services, and improvement of outcomes for all communities.

Recommendations:

· Establish funding incentives for recruitment and retention of mental health professionals in rural settings.
· Through a public and private partnership develop and implement comprehensive public health policies which reduce barriers to access, improve community outreach and engagement, and ensure development of culturally competent care to racial and ethnic minorities.

Commissioner Knight-Richardson acknowledged that the workforce problem is also addressed in Goal 4. He also commented upon the paucity of research in cultural competence. He noted that the final report would discuss these issues along with other cultural barriers to accessing quality mental health care.

Commissioner Lerner-Wren indicated she thought the current goal and recommendations omitted the Commission's discussion about gender disparities.

Commissioner Godbole commented that disparities occurred not only with accessing care, but also obtaining adequate quality care. Chair Hogan agreed a reference to the current inadequacy of care should be added.

Commissioner Arredondo made a motion to accept Goal 6, along with the recommendations and discussion, a motion, which Commissioner Godbole seconded. The Commission voted unanimously to accept Goal 6.

Vote to Accept Final Report Outline

Commissioner Speck moved that the Commission accept the outline as the framework for its final report. Chair Hogan elaborated that the Commission would be authorizing the drafting of a final report to include and be based upon the vision, goals, and recommendations discussed during the public meeting. Commissioner Speck accepted Chair Hogan's endorsement as part of her motion.

Commissioner Arredondo seconded the motion.

During the discussion period, Commissioner Mayberg questioned whether the group had omitted any important points.

Commissioner Harbin clarified that the Commission's vote to accept the outline also would include their most recent discussion; Commissioner Speck confirmed that her motion included the Commission's discussion.

Commissioner Yates recommended that certain topics be clarified and defined (e.g., collaborative care and evidence-based treatment) in the final report. The Commission's Subcommittees had used broad definitions for such terms and may be a resource.

Commissioner Curie suggested that the final report identify model programs and essential services and supports. As the Commission crafts the final document, model programs should be incorporated, as appropriate, into the framework of the outline. In addition, the Commission's entire record should be considered during the drafting of the final report.

Commissioner Godbole noted that the Executive Order had repeated references to public- private partnerships. He urged that the Commission's final report be responsive to those references.

Commissioner Carlile commented that the final report would be a living document that would influence the federal agency activities. After reviewing the final report, HUD would respond and take action - in addition to its current range of activities for people who have mental illnesses.

Commissioner Mayberg observed that the group had discussed various principles during its discussions. He proposed that the final report articulate the principles that drove the Commission's decision-making, many of which were also included in the Subcommittee reports.

The Commission voted unanimously to accept the outline containing the vision, goals, and recommendations, along with the pursuant discussion, and proceed with drafting the final report.

Public Comment

The following individuals provided verbal and written testimony to the Commission:

Irene Lynch, Executive Director, ALEPPOS Foundation
Dave Miers, Bryan LGH Medical Center, Lincoln Nebraska
Tina Minkowitz, New York Organization for Human Rights and Against Psychiatric Assaults
Jacki McKinney, National People of Color Consumer Survivor Network
Laura Van Tosh, Consumer
Mark Davis, Pennsylvania Mental Health Consumer Association
Laurie Ahern, National Empowerment Center
Leah Harris, National Association of Rights, Protection and Advocacy
Stephanie Reed, American Association for Geriatric Psychiatry

Final Comments

Commissioner Godbole shared a moving poem he wrote as a testimonial to his fellow Commissioners and their collective efforts on behalf of adults and children with mental illnesses.

In his final comments, Chair Hogan indicated that the final report should be completed in the next few weeks. Subsequently, the Subcommittee reports would be finalized and published as working papers to serve as resources for the field. He expressed appreciation to those who participated in and support the Commission's mission, including President Bush, Commission staff and consultants, mental health advocates, consumers and family members who contributed their thoughts through public testimony, letters, and the Commission's web site, and his wife Barbara Hogan.

Commissioner Fisher discussed the challenge of serving on the Commission as the only person self-identified as a consumer. He observed that, as the Commission discussed many difficult issues, the group was able to bridge many differences and identify common themes and concerns.

Commissioner Harbin thanked Chair Hogan for his leadership, hard work, and patience.

Commissioner Lerner-Wren observed that, as a result of their year-long endeavor, Commissioners had transformed both individually and collectively. She expressed appreciation to Commissioner Curie, Alternate Commissioner Hutchings, and NIMH officials for their leadership.

Commissioner Curie noted that many Commissioners would continue to serve on other advisory groups and councils. When the final report begins generating specific action plans, each person on the Commission will continue the momentum in their respective communities.

Chair Hogan adjourned the meeting at 12:10 p.m.

I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete.

Claire Heffernan
Executive Director
President's New Freedom Commission on Mental Health

Michael Hogan, Ph.D.
Chair
President's New Freedom Commission on Mental Health

These minutes were considered and approved by the Commission by mail in ballot and any corrections or annotations incorporated into the text.

Last Modified 5/6/03

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