president’s new freedom commission on mental health report overview pablo hernandez, m.d

President’s New Freedom Commission on Mental Health Report Overview

Pablo Hernandez, M.D.

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

President’s New Freedom Initiative

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


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


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


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


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


Goal 1

Americans Understand that Mental Health is Essential to Overall

Health


Goal 2

Mental Health Care Is Consumer and Family Driven


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.


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.



Involve consumers and families fully in orienting the mental health system toward

recovery.



Align relevant Federal programs to improve access and accountability for mental health

services.


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.



Create a Comprehensive State Mental Health Plan



Protect and enhance consumer’s rights



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


Goal 3

Disparities in Mental Health Services Are Eliminated



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



Improve access to quality care that is culturally competent.



Improve access to quality care in rural and geographically remote areas.


Goal 4

Early Mental Health Screening, Assessment, and Referral to

Services Are Common Practices



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



Promote the mental health of young children



Schools should have the ability to play a larger role in mental health care for children



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



Screen for co-occurring mental and substance abuse disorders and link with

integrated treatment and strategies



Screen for mental disorders in primary health care across the life span, and connect to treatment

and support


Goal 5

Excellent Mental Health Care is Delivered and Research is

Accelerated



Gaps between science and services have contributed to the failure to use known evidence-based practices

Research must better advise and advance services



Accelerate research to promote recovery and resilience, and ultimately to cure and prevent

mental illnesses



Advance evidence-based practice (EBPs) using dissemination and demonstration

projects and create a public-private partnership to guide their implementation



Improve and expand the workforce providing evidence-based mental health services and

supports



Develop the knowledge base in four understudied areas


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


Goal 6

Technology is Used to Access Mental Health Care and Information



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



Use health technology and telehealth to improve access and coordination of mental

health care, especially for Americans in remote areas or in underserved populations



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


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.


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 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.


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 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.


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 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.


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.


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.


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).


The Cost of Under-Investment in Mental Health– Hospital and Primary Care Costs– Corrections– Homelessness– Lost Productivity– Suicide


Mental Health Parity: Ending Insurance Discrimination


Access to Psychotropic Medication– Limiting Access to Medications is

Pennywise and Pound Foolish– Grading Criteria


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.


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.


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).


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.”

president’s new freedom commission on mental health report overview pablo hernandez, m.d

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