APA Contributes to Federal Action Agenda to Implement Recommendations of President's New Freedom Commission on Mental Health

Kathryn Power, M.Ed., Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
5600 Fishers Lane, Room 17-99
Rockville, MD 20857

Dear Ms. Power:

On behalf of the American Psychological Association (APA), I would like to thank you for this opportunity to contribute to the Action Agenda being developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) to prioritize and implement the recommendations of the President's New Freedom Commission on Mental Health.

First, let me emphasize that APA's overarching goal for our nation's mental health system is to provide comprehensive, consumer-oriented, family-focused, culturally-competent, and multidisciplinary services in all settings for people with mental disorders, particularly those with serious disorders. Comprehensive, multidisciplinary treatment would encompass psychological, medical, educational, legal, and social services as components of each individual's plan, as indicated, for treatment, rehabilitation, and recovery.

In keeping with your request, we have identified the three Commission recommendations that, in our judgment, offer the most promise for achieving the desired transformation of our nation's mental health system. The following list, in order of priority with explanatory comment, reflects the combined input of our APA Task Force on SMI/SED and four of our Public Interest Directorate committees and task forces that focus on special populations across the lifespan:

Recommendation 2.3: Align relevant Federal programs to improve access and accountability for mental health services. As the Commission noted, this recommendation addresses critical needs in our service delivery system, including: flexibility in funding, supportive employment and housing, an end to the Institutions for Mental Diseases (IMD) exclusion, and access to mental health services for individuals through our educational and justice systems. The creation of flexible funding streams enables agencies to commingle funds to provide the most appropriate services to an individual over time, including access to a comprehensive system of care.

In order to participate fully in society, individuals with serious mental disorders need to be gainfully employed. The research demonstrates that 60% to 80% of individuals with serious mental disorders are able to obtain a competitive job when supported employment is provided. Individuals with serious mental disorders are often in dire need of safe and affordable housing. The provision of such housing will decrease the number of homeless people, an estimated one-third of who have a serous mental disorder.

It has been well established that our nation's jails and prisons have become de facto mental health facilities housing approximately 300,000 people with serious mental disorders. Diversion programs and re-entry strategies must be adopted to reduce recidivism and avoid the unnecessary incarceration of non-violent adults and juveniles with serious mental disorders. On another front, serious problems arising from the Medicaid IMD exclusion must also be addressed directly.

Recommendation 5.3: Improve and expand workforce providing evidence-based mental health services and supports. As the Commission emphasized, there is an urgent need to train ethnically, culturally, and linguistically competent mental health providers to eliminate disparities in mental health care. There is also a pressing need for mental health providers that are trained to work with children, older adults, and people living in rural and geographically remote areas. In this regard, it is estimated that nearly two-thirds of children and older adults with a mental disorder do not receive needed services.

An array of effective interventions is now available, including psychosocial and psychopharmacological treatments, integrated community and preventive services, and school and home-based approaches. However, we must have a sufficient number of well-trained providers for these quality and culturally competent treatments to reach those individuals in need. Accordingly, every service system utilizing public funding should provide active and ongoing advanced clinical training in effective recovery and resilience interventions for all professional disciplines. We believe, however, that training providers in the most up-to-date and effective treatments must not be confined strictly to those that are evidence-based. As noted in the Commission report itself, all efforts to advance effective treatments should incorporate treatments categorized as emerging best practices.

Additional training for providers is critically needed in the area of psychological and behavioral treatments for working with individuals at risk for coercive control interventions, such as seclusion and restraint. APA would welcome the opportunity to work with SAMHSA to develop an appropriate curriculum and procedures for training providers in effective psychological and behavioral interventions to lessen the need for coercive interventions.

Recommendation 4.4: Screen for mental disorders in primary health care, across the life span, and connect to treatment and supports. There is growing awareness of the need to better integrate mental health into primary health care to promote overall physical health. Since primary care is often people's only access to health care, it is vital for primary care physicians to screen for mental disorders, which often co-exist with other physical disorders.

Most families when seeking care for a child first approach their pediatrician or local school for guidance. Likewise, it has been suggested that primary care is the best place for older adults to access mental health screening and referral for treatment. Clearly, screening for depression in primary care could help to prevent the tragedy of suicide, particularly among older adults. In this regard, it has been documented that 75% of older adults who had committed suicide had visited a physician in the previous month. Screening for mental disorders in primary care, with referral to mental health professionals for assessment and treatment, would provide many individuals with critically needed access to care.

In conclusion, I would like to thank you once again for this opportunity to contribute to the development of the Action Agenda. We look forward to continuing to work with you and SAMHSA to ensure that the vision set forth by the President's New Freedom Commission on Mental Health becomes a reality.