president’s new freedom commission on mental health report overview pablo hernandez, m.d
TRANSCRIPT
Overview
President’s New Freedom Commission on Mental Health
National Mental Health Association “Can’t Make the Grade”
NAMI TRIAD (Treatment/Recovery Information and Advocacy Database)
SAMSHA Priorities: Program & Principles Matrix
Evidence-Based Practices
The President’s New Freedom Commission on
Mental Health
Achieving the Goal
Transforming Mental Health Care in America
The President’s New Freedom Commission on Mental Health
“Americans with mental illness… deserve a health system that treats their illness with the same urgency as physical illness.”
President George W. Bush - April 29, 2002
The President’s New Freedom Commission on Mental Health
Three obstacles must be overcome:– Stigma– Fragmented mental health service
system– Unequal treatment and dollar limits for
mental health care in private health insurance.
President George W. Bush
April 29, 2002
The President’s New Freedom Commission on Mental Health
Interim Report Findings– Fragmentation and Gaps in Care - for Children– Fragmentation and Gaps in Care - for Adults
with Serious Mental Illnesses– High Unemployment and Disability for People
with Serious Mental Illness– Older Adults with Mental Illness Are Not
Receiving Care– Mental Health and Suicide Prevention Not Yet
National Priorities
The President’s New Freedom Commission on Mental Health
VISION
IT’S A FUTURE IN WHICH Everyone with mental illness will recover Mental illness can be --
– Prevented or cured– Detected early
Everyone of all ages with a mental illness has access to effective treatment and supports -- essentials for living, learning, and participating in the community
The President’s New Freedom Commission on Mental Health
Principles Underlying the Transformation
Care focused on: Promoting consumer’s ability to manage life’s
challenges successfully Facilitating recovery Building resilience, not just managing
symptoms
The President’s New Freedom Commission on Mental HealthThe Goals for a Transformed System
Goal 1. Americans Understand that Mental Health is Essential to Overall Health.
Goal 2. Mental Health Care is Consumer and Family Driven
Goal 3. Disparities in Mental Health Services are Eliminated
Goal 4. Early Mental Health Screening, Assessment, and Referral to Services are Common Practice
Goal 5. Excellent Mental Health Care is Delivered and Research is Accelerated
Goal 6. Technology is Used to Access Mental Health Care and Information
The President’s New Freedom Commission on Mental Health
Goal 1
Americans Understand that Mental Health is Essential to Overall
Health
The President’s New Freedom Commission on Mental Health
Goal 2
Mental Health Care Is Consumer and Family Driven
The President’s New Freedom Commission on Mental Health
Understanding the Goal
The failure to provide consumer- and family- driven care may contribute to:
An opaque system of care A system that places the burden of both
finding and coordinating care on the consumer/family.
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 2.1
Develop an individualized plan of care for every adult with a serious mental illness and child
with a serious emotional disturbance.
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 2.2
Involve consumers and families fully in orienting the mental health system toward
recovery.
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 2.3
Align relevant Federal programs to improve access and accountability for mental health
services.
The President’s New Freedom Commission on Mental Health
Accomplishing Recommendation 2.3
Realign programs to better meet consumer and family needs.
Coordinate Federal funding for health care with States’ resources to better address unique local needs.
Make supported employment widely available. Make housing with supports widely available. Address mental health problems in the criminal and
juvenile justice systems.
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 2.4
Create a Comprehensive State Mental Health Plan
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 2.5
Protect and enhance consumer’s rights
The President’s New Freedom Commission on Mental Health
Accomplishing Recommendation 2.5
Fully integrate adults and children into their communities as called for under Olmstead
Eliminate the need to trade custody for care End discrimination in public and private sectors.
Especially in employment Reduce the use of seclusion and restraint
The President’s New Freedom Commission on Mental Health
Goal 3
Disparities in Mental Health Services Are Eliminated
The President’s New Freedom Commission on Mental Health
Understanding the Goal
The failure to eliminate disparities in mental health care may contribute to:
Less access to care and a higher burden of disability for racial and ethnic minorities
Continuing disparate care in rural/frontier areas
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 3.1
Improve access to quality care that is culturally competent.
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 3.2
Improve access to quality care in rural and geographically remote areas.
The President’s New Freedom Commission on Mental Health
Goal 4
Early Mental Health Screening, Assessment, and Referral to
Services Are Common Practices
The President’s New Freedom Commission on Mental Health
Understanding the Goal
Insufficient early mental health screening and treatment across the life span
Poor detection in primary care settings and schools Pain and suffering for children and adults who have
or are at risk for co-occurring mental and addictive disorders
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 4.1
Promote the mental health of young children
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 4.2
Schools should have the ability to play a larger role in mental health care for children
The President’s New Freedom Commission on Mental Health
Accomplishing Recommendation 4.2
Urge Federal, State, and local child-serving agencies to recognize and address the mental health needs of youth in the education system
Collaborate with families to develop, evaluate, and disseminate effective mental health services and supports to youth in schools
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 4.3
Screen for co-occurring mental and substance abuse disorders and link with
integrated treatment and strategies
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 4.4
Screen for mental disorders in primary health care across the life span, and connect to treatment
and support
The President’s New Freedom Commission on Mental Health
Goal 5
Excellent Mental Health Care is Delivered and Research is
Accelerated
The President’s New Freedom Commission on Mental Health
Understanding the Goal
Gaps between science and services have contributed to the failure to use known evidence-based practices
Research must better advise and advance services
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 5.1
Accelerate research to promote recovery and resilience, and ultimately to cure and prevent
mental illnesses
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 5.2
Advance evidence-based practice (EBPs) using dissemination and demonstration
projects and create a public-private partnership to guide their implementation
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 5.3
Improve and expand the workforce providing evidence-based mental health services and
supports
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 5.4
Develop the knowledge base in four understudied areas
The President’s New Freedom Commission on Mental Health
Accomplishing Recommendation 5.4 Develop comprehensive minority mental health
research program Study effects of long-term medication use Examine impact of trauma on mental health,
particularly for women, children and victims of violent crime
Address acute care issues for persons in crisis who need a safe and intensive treatment setting
The President’s New Freedom Commission on Mental Health
Goal 6
Technology is Used to Access Mental Health Care and Information
The President’s New Freedom Commission on Mental Health
Understanding the Goal
Mental health care needs to capitalize on new, but underutilized, new health care technologies:
Electronic personal health records Use of Internet for communications and self-help Telemedicine and other treatment-related
technologies
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 6.1
Use health technology and telehealth to improve access and coordination of mental
health care, especially for Americans in remote areas or in underserved populations
The President’s New Freedom Commission on Mental Health
Achieving the Goal: Recommendation 6.2
Develop and implement integrated electronic health record and personal health
information systems
National Mental Health Association“Can’t Make the Grade”
Tricky Business: Medicaid and Mental Health– Cutting payment rates to providers.– Instituting preferred drug lists for
medications.– Reducing benefits and services.– Reducing eligibility levels for
Medicaid.
NAMI TRIADTreatment/Recovery Information and Advocacy Database
Step1: Consumer and Family Centered Care
Step 2: Applying the Evidence Step 3: Funding Step 4: Ending the Barriers to Recovery Step 5: Public Accountability and
Information Technology Step 6: A Role for All of Us
NAMI TRIADTreatment/Recovery Information and Advocacy Database
Step 1: Consumer and family-centered. Long standing evidence-based knowledge that the involvement of consumers and families is crucial for healthcare. Institute of Medicine reports have spoken about this in many publications.
Consumer and family-centered care values the desired outcomes of the individual and families dealing with a mental illness.
NAMI TRIADTreatment/Recovery Information and Advocacy Database (Step 1 continued)
Action plans and recommendations: To expand peer provided services to all individuals with serious mental disorders and their families (to SAMHSA).
To the National Institute of Mental Health to study the impact of peer provided services, its efficacy, effectiveness, cost effectiveness, outcomes and best methods for implementation.
NAMI TRIADTreatment/Recovery Information and Advocacy Database
Step 2: Applying evidence-based. IOM report observed the need of healthcare system revolution requiring systemic changes and utilizing evidence-based interventions and practices.
Actions: The mental health authority needs to develop a plan to expand evidence-based practices, including:
Medication management, assertive community treatment, supportive employment, dual/co-occurring disorders (mental illness/substance abuse), supportive
housing, and jail diversion programs.
NAMI TRIADTreatment/Recovery Information and Advocacy Database (Step 2 continued)
NAMI calls to NIMH the report “Bridging Science and Service.”
Dissemination of interventions shown to produce positive outcomes, translating research into practice, translating activities in the real world, and modifying the research agenda to include families and consumers.
NAMI calls for the Institute of Medicine study on effectiveness and quality of mental healthcare providers, including a review of training, licensing and other credentialing mechanisms, workforce capacity, and the use of effective, evidence-based interventions.
NAMI TRIADTreatment/Recovery Information and Advocacy Database
Step 3: Funding. The IOM Report noted that financing of healthcare must
be aligned with quality improvement to understand where the taxpayers’ dollars are going and how appropriately they are being spent.
NAMI calls for major payers of mental health services, including Medicaid, Medicare, state governments and employers to develop and implement payment strategies that support implementation of evidence-based, recovery-oriented services for individuals with severe mental illness and their families (SAMHSA should monitor these efforts).
NAMI TRIADTreatment/Recovery Information and Advocacy Database (Step 3 continued)
NAMI calls NIMH to commission a study that proves the cost of mental illness to society and the current funding of the public mental health system.
NAMI calls for states not to target budget reductions that are essential for interventions to the safety and health of individuals with serious mental illness, such as formulary restrictions and reduction of essentially needed programs.
NAMI TRIADTreatment/Recovery Information and Advocacy Database
Step 4: Ending the barriers to recovery. There are many barriers to appropriate care and recovery, especially employment and housing. Again, the IOM report noted the barriers are very large and do exist (Crossing the Quality Chasm).
Stigma, discrimination, poverty, and lack of culturally appropriate services.
NAMI urges Congress to hold a series of hearings on persistent barriers to employment and to eliminate barriers such as SSI/SSDI, Medicaid, Medicare and other programs. NAMI urges the passage of federal legislation to address health insurance parity.
NAMI TRIADTreatment/Recovery Information and Advocacy Database (Step 4 continued)
NAMI calls on the U.S. Department of Justice and other appropriate federal and state agencies to force the law and punish those that illegally discriminate against people with mental illness in housing, employment and access to community services.
NAMI TRIADTreatment/Recovery Information and Advocacy Database
Step 5: Public accountability and information technology. Outcomes for individuals that have meaningful value to their recovery, not just symptom management should include employment, housing. This needs to be further validated through investment in infrastructure and technology that is required for reforms in the mental health system. Usage of information technology in frontier and rural areas will enhance access to care.
NAMI TRIADTreatment/Recovery Information and Advocacy Database
Step 6: A role for all of us. “Crossing the Quality Chasm” notes that to
see significant improvement, all of the stakeholders in the healthcare system must be engaged in the enormous task of reform, which requires strong coalition of advocates, providers and policy makers at all levels, from planning to the implementation; from policies to standards.
NAMI TRIADTreatment/Recovery Information and Advocacy Database (Step 6 continued)
Education to the public about mental illness. Dispelling ignorance and prejudice, and providing information about effective and appropriate treatment. Example: Consumer and family-provided education and support, peer to peer program, NAMI CARE and In Our Own Voice. NAMI’s Campaign for the Mind of America, multi-year effort to promote investment in recovery and prevent abandonment of yet another generation of Americans with mental illness.
The TRIAD which is a treatment/recovery information and advocacy database.
Grassroots advocacy (http://www.NAMI.org).
National Mental Health Association“Can’t Make the Grade”
The Cost of Under-Investment in Mental Health– Hospital and Primary Care Costs– Corrections– Homelessness– Lost Productivity– Suicide
National Mental Health Association“Can’t Make the Grade”
Mental Health Parity: Ending Insurance Discrimination
National Mental Health Association“Can’t Make the Grade”
Access to Psychotropic Medication– Limiting Access to Medications is
Pennywise and Pound Foolish– Grading Criteria
National Mental Health Association“Can’t Make the Grade”
Beyond Grades: Mental Health Policy Trends– Increasing Consumer Involvement– Promoting Diversity Among Mental Health
Providers– Enhancing Availability of Medicaid
Community-Based Services.– Reducing Disincentives to Work.– Decreasing the Number of People with
Mental Illnesses in the Justice System– Supporting Community-Based Services.
National Mental Health Association“Can’t Make the Grade”
State Offices of Consumer Affairs: Increasing Consumer Involvement– Requiring consumer and family involvement
on all health and mental health advisory boards.
– Employing mental health consumers and family members within state mental health agencies as well as other agencies that provide mental health services.
– Establishing an Office of Consumer Affairs.
National Mental Health Association“Can’t Make the Grade”
Promoting Diversity Among Mental Health Providers– 84% of psychologists were non-Hispanic white
(compared to 74% of the total population).– 10% of psychologists were black/African American
(compared to 12% of the total population).– 4% of psychologists were Hispanic/Latino
(compared to 11% of the total population).– 3% of psychologists were Asian American & Pacific
Islander (compared to 4% of the total population).– 1% of psychologists were American Indian/Alaskan
Native (compared to 1% of the total population).
National Mental Health Association“Can’t Make the Grade”
Promoting Diversity Among Mental Health Providers (cont.)– For full-time doctoral departments of
psychology, 82% of students are white, 6.4% black, 5.0% Hispanic, 5.7% Asian American, and .8% Native American.
– For part-time doctoral departments of psychology, 79% of students are white, 11.2% are black, 5.9% are Hispanic, 2.8% are Asian, and .8% are Native American.
Evidence-Based Practices
Illness Management and Recovery Medication Management
Approaches in Psychiatry (MedMAP)
Assertive Community Treatment
Evidence-Based Practicescontinued
Family Psychoeducation Supported Employment Co-Occurring Disorders: Integrated
Dual Disorders Treatment
More Stuff
The Positive Aging Act of 2003 (S. 1456) & (H.R. 2241) are designed to integrate mental health screening and services in primary care and promote geriatric mental health outreach to seniors.
Los Angeles County Mental Health has created a progressive, evidence-based model of continuum of care for adolescents and adults with co-occurring disorders.
More than half of adults with serious mental illness go untreated according to the 2001 National Household Survey on Drug Abuse. According to Charles Curie, “Fewer than half of the 15 million adults with serious mental illness in the United States are receiving treatment” The data show racial disparities and educational differences as well.”