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Chair Michael Hogan convened the second meeting of the President's
New Freedom Commission on Mental Health on August 7 - 8, 2002 at the
Crystal Gateway Marriott, 1700 Jefferson Davis Highway, Arlington,
VA. In accordance with the provisions of Public Law 92-463, the meeting
was open to the public on August 7, from 3:30 p.m. to 6:00 p.m., and
on August 8, from 8:30 a.m. to 3:47 p.m., when the meeting adjourned.
Commission Members Present:
Michael F. Hogan, Chair
Jane Adams
Rodolfo Arredondo, Jr.
Daniel B. Fisher
Anil G. Godbole
Henry T. Harbin
Larke N. Huang
Norwood W. Knight-Richardson
Ginger Lerner-Wren
Stephen W. Mayberg
Robert N. Postlethwait
Nancy C. Speck
Randolph J. Townsend
Deanna F. Yates
Ex Officio Representatives Present:
Charlie Curie, Substance Abuse and Mental Health Services Administration
Wayne Fenton for Richard Nakamura, National Institute of Mental Health
Laurent Lehman and Al Batres for Frances Murphy, Department of Veterans
Affairs
Richard Nakamura, National Institute of Mental Health
Robert Pasternak, Department of Education
Patricia Carlile, Department of Housing and Urban Development
Gail Hutchings for Charlie Curie, Substance Abuse and Mental Health
Services Administration
Staff Members Present:
Claire Heffernan, Executive Director
Stanley Eichenauer, Deputy Executive Director
James Finley, Senior Policy Analyst
Dawn Foti, Health Policy Analyst
Patty Ditoto, Administrative Assistant
Kevin Hennessy, Senior Advisor
Elaine Viccora, Consultant
Presenters who attended portions of the meeting were:
Ethleen Iron Cloud-Two Dogs, Program Director, Oglala Lakota, Lakota
Nation,
Wakanyeja Wape Tokeca, Porcupine, South Dakota
Ruby Martinez, Assistant Professor, University of Colorado, School
of Nursing; and Secretary, National Latino Behavioral Health Association
King Davis, Professor of Mental Health and Social Policy, University
of Texas at Austin; and Chairman, National Leadership Council on African-
American Behavioral Health
Steven Shon, Medical Director, Texas Department of Mental Health and
Mental Retardation; and Chairman, Board of Directors, National Asian-American
and Pacific Islander Mental Health Association
Judith Cook, Professor of Psychiatry, University of Illinois at Chicago,
Department of Psychiatry
August 7, 2002
Introduction and Agenda Overview
Dr. Hogan convened the meeting at 3:30 p.m. and provided a context
for the expert panel on cultural competency. He stated that the major
issues in mental health services - access to care, quality of care
and outcomes of care - are all worse for members of the minority U.S.
population than for white Americans and require broad examination.
Norwood Knight-Richardson, Chair of the Subcommittee on Cultural Competence,
introduced the panel members.
Expert Panel Presentation-Cultural Competence
Ethleen Iron Cloud-Two Dogs, Program Director, Oglala Lakota, Lakota
Nation,
Wakanyeja Wape Tokeca, Porcupine, South Dakota
Ruby Martinez, Assistant Professor, University of Colorado, School
of Nursing; and Secretary, National Latino Behavioral Health Association
King Davis, Professor of Mental Health and Social Policy, University
of Texas at Austin; and Chairman, National Leadership Council on
African-American Behavioral Health
Steven Shon, Medical Director, Texas Department of Mental Health
and Mental Retardation; and Chairman, Board of Directors, National
Asian-American and Pacific Islander Mental Health Association
Ethleen Iron Cloud-Two Dogs, Program Director, Oglala Lakota, Lakota
Nation, Wakanyeja Wape Tokeca, Porcupine, South Dakota spoke about
the mental health program she directs which serves the Lakota people.
Her program provides accessible mental health resources and training
that are culturally and community competent. She focused on the high
rate of suicide among Lakota youth, stating that young people kill
themselves at a rate four to six times the national average and that
the future of the Lakota people is literally dying. She attributed
the high suicide rate to centuries of genocidal and oppressive policies,
as well as unresolved trauma. Native Americans rely on the Indian
Health Service to provide mental health services, but it is funded
only at 30 - 40 percent of the actual need. The Lakotas have just
two mental health clinics on their reservation of over 5,000 square
miles. This geographic isolation severely limits access to services.
Given the limited resources, programs often provide only crisis response
services, such as responding to suicide attempts, and are unable to
provide much long-term therapeutic care. She made four recommendations
to the Commission: 1) acknowledge through policy and practice that
most tribal nations have a unique treaty relationship with the government;
2) increase funding for services to levels where programs can provide
actual therapy; 3) provide ongoing training resources for consumers
and communities so mental health needs are addressed before they reach
a crisis; and 4) devote sufficient resources so that research methods
and findings are culturally relevant (e.g., translate research instruments).
A copy of the presentation is available on the Commission's website:
www.mentalhealthcommission.gov.
Ruby Martinez represented the National Latino Behavioral Health Association
and addressed the mental health needs of Latinos, who currently make
up about 13 percent of the U.S. population. She described current
barriers to services including: limited language proficiencies of
providers, lack of insurance, fragmented systems, workforce limitations
and a lack of health care professionals who are ethnic minorities.
She recommended that institutions of higher learning and service providers
integrate cultural competency standards within their curriculum and
practice requirements.
Dr. King Davis spoke on behalf of the National Leadership Council
on African-American Behavioral Health, an organization of African
American consumers, family members, providers, ministers, educators
and others. He discussed the benefits of providing culturally competent
services and better meeting the needs of minority populations, including
potential cost savings due to less reliance on inpatient care, reduced
recidivism and lower rates of diagnostic errors. He suggested several
policy recommendations: prioritize the development of quality mental
health services for people of color, develop and fully implement cultural
competency standards, provide a variety of supports for family members,
and involve African Americans and other minority populations in research.
A copy of this presentation is available on the Commission's website:
www.mentalhealthcommission.gov.
Dr. Steven Shon presented the views of the National Asian-American
and Pacific Islander Mental Health Association. He referred to the
Surgeon General's report, Mental Health: Culture, Race and Ethnicity,
which made four major findings about discrepancies due to race and
ethnicity. These discrepancies include 1) less access to and availability
of mental health services; 2) less likelihood of receiving needed
mental health services; 3) poorer quality care in treatment; and 4)
under representation in research. He also described characteristics
of Asian American and Pacific Islanders, which she said are the fastest
growing racial groups in this country. He maintained that making services
more culturally appropriate does not necessarily require new resources
- that sometimes it is a matter of using existing resources more efficiently.
The Surgeon General's report also featured a number of recommendations
for future improvements in services, including expanding the science
base and developing training modules and curricula for use in service
systems and universities. A copy of this presentation is available
on the Commission's website: www.mentalhealthcommission.gov.
A period of questions and answers followed between the Commission
and presenters. Questions covered many issues raised by the presenters
including training issues, the extent to which other cultures should
assimilate the culture of mental health services, and the availability
and implementation of standards for measuring the cultural competence
of a service system. Dr. Hogan recessed the Commission at 6:00 p.m.
until 8:30 a.m. August 8.
August 8, 2002
Dr. Hogan reconvened the Commission at 8:35 a.m. and introduced the
morning speaker, Dr. Judith Cook, a leading researcher on employment
for people with serious mental illness.
Expert Presentation-Employment and Income Support
Judith Cook, Professor of Psychiatry, the University of Illinois
at Chicago, Department of Psychiatry
Dr. Cook's presentation focused on the fact that there is substantial
evidence that people with mental illnesses want to work and that newer
research indicates that consumers can successfully participate in
a competitive labor market. But for consumers to enter and remain
in the labor force, she said they usually need carefully coordinated
clinical and vocational services provided by multidisciplinary teams.
She said another crucial factor for success is ongoing employment
supports. However, many mental health consumers receive little or
no services to help them secure or retain employment; what services
they do receive have been found to be of limited effectiveness. She
described several other barriers for people with severe mental disorders
including the lack of necessary training and education and job discrimination,
including negative attitudes from employers.
She went on to describe the major problems with the disability income
support programs Supplemental Security Income (SSI) and Social Security
Disability Income (SSDI). The primary issue is that the level of income
support payments is barely at the poverty level. In addition, very
few recipients with severe mental illness ever get off SSI or SSDI
because the program rules create disincentives to work. For example,
eligibility for health insurance benefits is linked directly to their
SSI/SSDI benefits. Individuals who lose disability income status also
lose health insurance and other benefits, such as housing subsidies.
She said that reforms of the SSI and SSDI programs, such as the Ticket
to Work, are not having their intended effect and do not attract vocational
providers.
Dr. Cook noted that billions of dollars are spent on vocational models
such as sheltered work that have no demonstrated effectiveness for
people with severe mental illness. She suggested several remedies:
provide post-secondary education and training to people with mental
illnesses so they can compete in the marketplace, change disability
income support policies that create disincentives to employment, and
make employment and income support part of the recovery process for
consumers. Commissioners engaged in a question and answer period with
Dr. Cook and probed many of the issues raised in her presentation.
A copy of this presentation is available on the Commission's website:
www.mentalhealthcommission.gov.
Public Comment
Dr. Hogan introduced the period for public comment by reviewing procedures
for speakers, including a three-minute time limit. Members of the
public who spoke were: Mike Faenza, Stephanie Reed, Michael Allen,
Joyce Edelson, Marie Jose Currasco, Linda Powell, David Sanders, Arnie
Kuhl, Glen Koons, and Sol Jacobson.
Work Session
Dr. Hogan asked each subcommittee to briefly summarize the status
of their work. Reports were provided by the Subcommittees on Evidence
Based Practice, Medication Issues, Criminal Justice, Children and
Families, Rights and Engagement, Cultural Competence, Rural Issues,
Interim Report, Suicide Prevention, Co-occurring Disorders, Employment
and Income Support, Interface of General Health and Mental Health,
and Consumer Issues. Commissioners engaged in questions and answers
about the Subcommittees reports, suggesting areas for future Subcommittee
attention. These written subcommittee reports are available on the
Commission website: www.mentalhealthcommission.gov.
Adjournment and Next Meeting Announcement
Dr. Hogan thanked all the presenters and the meeting adjourned at
3:47 p.m. The next meeting of the Commission will be on September
11 - 12 in Chicago, Illinois.
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 at its
September 11, 2002 meeting and any corrections or notations incorporated
into the text.
Last Modified 09/16/02
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