Approximately 30 percent of the nation's adults suffer from a diagnosable mental health disorder and 20 percent of children show signs of a diagnosable mental health disorder in the course of a year, yet many of these people have slipped through the cracks of the mental health system, according to the final report of the president's New Freedom Commission on Mental Health, released in late July.
In its report, the commission offers strategies--such as eradicating stigma and making mental health care more consumer-driven--to mend the cracks in the system and improve care. In the report, the commission also supports the call by President George W. Bush for federal legislation to provide full parity between insurance coverage for mental health and physical health care. The hope of the report's crafters is that President Bush and his administration, Congress and the states work to implement their suggested changes, say members of the commission, which included three APA members:
Deanna Yates, PhD, a private practitioner in San Antonio and president of the Texas Psychological Association.
Larke Nahme Huang, PhD, director of research at the Center for Child Health and Mental Health Policy at Georgetown University.
Stephen Wright Mayberg, PhD, director of the California Department of Mental Health.
Bush formed the commission last year and charged the panel of experts with the first comprehensive study of the nation's public and private mental health delivery system since President Jimmy Carter's 1978 Mental Health Commission.
What the recent commission says it found is a mental health system in disarray--a "really crumbling system where there are well-meaning people and providers, but policy and finance pieces that really need to be rebuilt," says Huang.
For example, she says, commissioners were "constantly told the system was complex and hard to negotiate at state and local levels," and that fragmented services caused trouble for both patients and providers. To make a more seamless, coordinated system of care at state and local levels, federal changes need to occur, she adds.
Indeed, the United States spends approximately $71 billion on mental illnesses, and most of that reflects loss of productivity due to illness or premature death, the report says.
Goals for the future of mental health
To spark the necessary changes, the commission offered six broad-based goals:
Americans need to understand that mental health is essential to overall health. The commissioners recommend that a national campaign to reduce stigma surrounding seeking mental health care be launched, as well as a campaign to prevent suicide.
Mental health care should be more consumer- and family-driven. This means, according to recommendations from the commission, that every adult and child with a serious mental illness or disturbance is given an individualized plan of care.
Disparities in mental health services ought to be eliminated. To do this, the commissioners note, mental health care must be culturally competent, accessible and available in geographically remote areas.
Early mental health screening, assessment and referral to services should become common practice. Co-occurring mental and substance abuse disorders should also be screened for and linked with integrated treatment strategies, the report recommends.
Providers need to deliver excellent mental health care, and research needs to be accelerated. The commissioners recommend that state-of-the-art treatment and best practices be advanced through demonstration projects and that the work force be improved through these practices.
Technology--such as telehealth and integrated electronic health records--ought to be used to access mental health care and information.
With those changes in place, the nation would have a significantly more effective mental health system, the commissioners argue, specifically noting in the report that, "We envision a future when everyone with a mental illness will recover, a future when mental illnesses can be prevented or cured, a future when mental illnesses are detected early, and a future when everyone with a mental illness at any stage of life has access to effective treatment and supports--essentials for living, working, learning and participating fully in the community."
Though "not every psychologist will resonate with each one of the goal areas, we're hoping that there will be areas that stakeholders will feel strongly about," says Huang.
For Yates's part, she predicts that psychologists will respond most positively to the report's recognition of the importance of emerging best practices and related research, and for stronger collaborative practice models.
"We hope states will look at this as a model," says Yates. Ideally, states will then create demonstration projects based on the report's recommendations, she says.
"The biggest concern is that recommendations get supported and implemented," Yates says. "We don't want a report that will sit and not be acted on. We hope people will take it and run with it."
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