President's New Freedom
Contact Mark Weber
President Bush's New Freedom Commission on Mental Health today presented its final report Achieving the Promise: Transforming Mental Health Care in America to the President, as part of a week-long recognition of the anniversary of the Americans with Disabilities Act. The product of a year of study, the report finds that the nation's mental health care system is beyond simple repair.
Building on research, expert testimony and input from over 2,300 consumers, family members, service providers and others, the report concludes that "traditional reform measures are not enough...". Instead, it recommends a wholesale transformation that involves consumers and providers, policymakers at all levels of government, and both the public and private sectors.
Commission Chair Michael F. Hogan, Ph.D., Director of the Ohio Department of Mental Health, declared "The time has long passed for yet another piecemeal approach to mental health reform. For too many Americans with mental illnesses, mental health services and supports they need are disconnected and often inadequate. The commission has found that the time has come for a fundamental transformation of the Nation's approach to mental health care. This report provides the President with a roadmap for that transformation. The destination is recovery. We ask consumers, family members, service providers, other members of the mental health community and all Americans - to join us on that journey."
The commission finds that the current system is unintentionally focused on managing the disabilities associated with mental illness rather than promoting recovery, and that this limited approach is due to fragmentation, gaps in care, and uneven quality. These systems problems frustrate the work of many dedicated staff, and make it much harder for people with mental illness and their families to access needed care. Instead, the commission recommends a focus on promoting recovery and building resilience-the ability to withstand stresses and life challenges.
The approach recommended by the commission will move toward full community participation for children and youth, adults, and older Americans with mental illnesses-instead of school failure, institutionalization, long-term disability, and homelessness. The commission presents the President with six goals and a series of specific recommendations for federal agencies, states, communities, and providers nationwide. Together, working through both the public and private sectors, the recommendations would achieve the needed transformation in care, and put limited resources to their best use.
The goals the commission articulates underscore the urgency and
magnitude of the changes it proposes. The commission believes that
Americans must come to understand that mental health is integral to
their overall health, and recommends that mental illnesses be addressed
with the same urgency as other medical problems. The stigma attached
to mental illness, which discourages people from seeking care, must
Members of minority groups and people in rural areas, the commission finds, have worse access to care, and often receive services that are not responsive to their needs. As a result, the burden of mental illness is heavier for these individuals. The commission urges a commitment to services that are "culturally competent"-acceptable to and effective for people of varied backgrounds.
The commission's review finds that too often, mental illness is detected
late not early, and that as a result, services frequently focus on
living with disability, not the better outcomes associated with effective
early intervention. Therefore, the commission recommends a dynamic
shift in care, moving toward a model that emphasizes early intervention
and disability prevention. As the panel notes, "early detection,
assessment, and linkage with treatment and supports can prevent mental
health problems from compounding and poor life outcomes from accumulating..."
The commission finds that effective services and supports validated by research find their way into practice too slowly. It calls for a more effective process to make "evidence-based practices" the bedrock of service delivery. This will require that payers of mental health care reimburse such practices, that universities and professional groups support training and continuing education in research-validated interventions. Acknowledging significant progress in research on mental illnesses, the panel urges the elimination of the 15-20 year lag between the discovery of effective treatments and their wide use in routine patient care. It highlights the need for accelerated and relevant research to promote recovery and, ultimately, to cure and prevent mental illnesses.
The commission recommends that the mental health system move more effectively to harness the power of communications and computer technology to improve access to information and to care, and to improve quality and accountability. With strong protections for privacy, these technologies can improve care in rural areas, help prevent medical errors, and reduce paperwork.
Throughout the report, the commission identifies private and public-sector
model programs that provide examples of how aspects of mental health
care have been transformed in selected communities.
These examples of innovation-across America, across the age span, and addressing many needs-illuminate how dramatic change is possible, and serve as beacons for the broader improvements recommended by the commission.
With presentation of the report to the President, the charge to
the commission has been fulfilled. Its findings, goals and recommendations
are designed to be assessed and carried forward not only by federal
agencies and offices, but also by states and communities, and public
and private providers, nationwide. The commission urges all shareholders
in mental health to work together to make recovery from mental illness
the expected outcome.