The federal government is aligning resources in an unprecedented collaborative effort to help ensure that people with mental illness have every opportunity for recovery. Six cabinet-level departments—Education, Health and Human Services (HHS), Housing and Urban Development, Justice, Labor, Veterans Affairs, and the Social Security Administration—have detailed 70 specific steps in a mental health action agenda. The agenda was released in late July, one week before the Campaign for Mental Health Reform, which represents 16 national advocacy and professional organizations, proposed a similar 28-step "roadmap" for transformation. Both the agenda and the roadmap seek to implement the recommendations of the President's New Freedom Commission on Mental health, whose report was released in July 2003.
Transforming Mental Health Care in America. The Federal Action Agenda: First Steps is the beginning of a multiyear effort to alter the form and function of the mental health system. "The Action Agenda is not a 'quick fix' for the problems that have ailed the mental health care system for decades. It is a living document that begins to chart the course for the long term," said Charles G. Curie, M.A., A.S.C.W., administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), which led the development of the action agenda. "The public sector is the major financial driver in mental health care, and transformation is a shared responsibility. Federal agencies must act as leaders, partners, and facilitators. States, however, will be the centers of action for system transformation."
Highlights of the federal agenda include to:
• Reinforce the message that mental illnesses and emotional disturbances are treatable and that recovery is the expectation
• Act immediately to reduce the number of suicides through implementation of the National Strategy for Suicide Prevention, launched by HHS in 2001
• Help states develop infrastructure to formulate and implement comprehensive state mental health plans that include the capacity to create individualized treatment plans that promote resilience and recovery
• Develop a plan to promote a mental health workforce better qualified to practice care that is culturally sensitive and based on evidence-based practices in specialty settings and in primary care
• Initiate a national effort focused on the mental health needs of children and promote early intervention with informed parental consent for at-risk children
• Expand the "Science-to-Services" agenda to develop new toolkits outlining evidence-based practices
• Increase the employment of people with psychiatric disabilities
• Design and initiate an electronic health records system that will help providers and consumers better manage care and that will protect confidentiality.
"The reason for the Action Agenda is simple," Curie explained. "People with mental disorders have a vital role to play in our families, our neighborhoods, our communities, and our country. Their ability to participate fully can no longer be derailed by outdated science, outmoded financing systems, and unspoken discrimination."
The action steps are related to five principles outlined in the Executive Order that created the President's New Freedom Commission. Principle D calls for a focus on how findings of mental health research can be used most effectively to influence the delivery of services. Among 12 action steps related to Principle D is an acceleration of research to reduce the burden of mental illnesses, which calls on the National Institute of Mental Health (NIMH) to reorganize and streamline research to produce new interventions with the ultimate goal of preventing or curing mental illnesses. A second step is to expand SAMHSA's National Registry of Evidence-Based Programs and Practices. To do so, SAMHSA will develop a procedure to identify, review, and summarize evidence-based practices in mental health care; survey the implementation of evidence-based practices in parallel fields, such as primary care; and recommend a procedure through which consensus might be developed across key mental health groups, consumers, and family members regarding implementation of evidence-based practices.
Another action step under Principle D calls for the development of new toolkits on specific evidence-based practices, in areas such as children's services, supportive housing, older adults, trauma and violence, collaborative models in primary care, consumer-operated service approaches, and supported education. Expansion of the "Science-to-Services" agenda, a related action step, will be led by the Center for Mental Health Services and NIMH. The goal is to identify evidence-based and promising practices that warrant further research, those that are ready for field implementation, and those that can and should be funded at the state and local levels. To implement another Principle D step, the elimination of disparities in care, NIMH is committing additional support to several of its programs: the Advanced Centers for Mental Health Disparities Research, the Disparities in Mental Health Services Research Program, the Socio-Cultural Research Program, the Office of Special Populations, and the Office of Rural Mental Health.
Complementing the federal plan for system transformation is the 28-step roadmap—Emergency Response: A Roadmap for Federal Action on America's Mental Health Crisis—developed by the Campaign for Mental Health Reform. The Campaign was formed in 2003 as the mental health community's united voice on federal policy. Among its 16 member organizations are the American Psychiatric Association, American Psychological Association, American Academy of Child and Adolescent Psychiatry, Depression and Bipolar Support Alliance, National Alliance for the Mentally Ill, National Association of State Mental Health Program Directors, National Empowerment Center, and National Mental Health Association (NMHA).
"Since the release of the Commission's report," said Michael Faenza, president and CEO of NMHA, "63,000 Americans have died by suicide; more than 200,000 Americans with mental illnesses have been incarcerated; more than 25,000 families have given up custody of their children in order to get mental health services; juvenile detention centers have spent $200 million 'warehousing' youth in juvenile justice facilities instead of providing treatment; and the American economy has lost more than $150 billion in productivity due to unaddressed mental health needs."
Among the 28 action items included in the roadmap are proposals by the Campaign to:
• End discrimination by health insurance plans through enactment of parity legislation this year
• Better utilize Medicaid dollars by providing cost-effective home- and community-based care in lieu of institutional care and by permitting states to use Medicaid dollars for comprehensive treatment plans
• Allow families to buy into Medicaid to obtain services for children with disabilities
• End the "warehousing" of youths with mental disorders
• End discrimination against mental health treatment in Medicare, which requires higher copayments for mental health outpatient care and limits inpatient psychiatric hospital coverage
• Provide early detection and intervention services to mothers and children who receive health care at federally funded maternal and child health clinics
• Permit presumptive eligibility for Supplemental Security Income and Medicaid for people who are homeless and have a serious mental illness
• Fund programs to divert people with mental illnesses who have committed nonviolent crimes into treatment instead of jail or prison.
The federal agenda is available on the SAMHSA Web site at www.samhsa.gov (click on Mental Health Action Agenda). The roadmap of the Campaign for Mental Health Reform can be found on the Campaign's Web site at www.mhreform.org/emergency.
Suicide prevention film available: A film aimed at preventing suicide among college students is now available from the American Foundation for Suicide Prevention. "The Truth About Suicide: Real Stories of Depression in College" provides information about depression, including its symptoms and association with suicide, and encourages students to seek help if they suspect they have a problem. The film is available in both DVD and VHS formats and comes with a facilitator's guide containing supplementary resource materials and recommendations for using the film effectively on campus. Orders may be placed by calling (888) 333-AFSP, ext. 10. The cost is $19.95, including shipping and handling. More information and resources are posted online at www.afsp.org/collegefilm.
Clinical support for physicians who treat opiate-dependent patients: The Substance Abuse and Mental Health Services Administration (SAMHSA) has launched the Physician Clinical Support System (PCSS) in collaboration with the American Society of Addiction Medicine (ASAM) and other specialty addiction medicine, psychiatric, pain, and general medicine societies. The system is designed to assist physicians in the appropriate use of buprenorphine for patients who are dependent on heroin or prescription drugs containing opiates. The PCSS is a national network of 45 trained physician mentors with expertise in addiction treatment, who are supported by a PCSS medical director and by five physicians who are national experts in the use of buprenorphine. The physicians provide services via telephone or e-mail or at the place of clinical practice. The PCSS is a free service. To find a PCSS clinician, to become a PCSS mentor, or for more information, e-mail the PCSS staff at email@example.com, call 877-630-8812, or fax 301-656-3815, or visit the PCSS Web site at www.PCSSmentor.org.
$92 billion in lost productivity from smoking deaths: Smoking cost the United States about $92 billion each year in the form of lost productivity between 1997 and 2001, up about $10 billion a year from the 1995 to 1999 estimates, according to new data from the Centers for Disease Control and Prevention (CDC). Smoking-related health care costs were estimated at $75.5 billion in 1998. Thus the annual cost of smoking exceeds $167 billion per year. The report found that between 1997 and 2001 an estimated 438,000 premature deaths occurred each year as a result of smoking and exposure to secondhand smoke. In comparison, approximately 440,000 smoking-related deaths were estimated to have occurred annually from 1995 to 1999. Smoking, on average, reduces adult life expectancy by approximately 14 years. More information from the report is available on the CDC Web site at www.cdc.gov/tobacco.