Position Statement 14: The Federal Government's Responsibilities for Mental Health Services
Policy Position
Mental Health America urges that the federal government take a leading role, in partnership with the states, in the development of recovery-oriented mental health services throughout the United States that are comprehensive, community- and strengths-based and consumer- and family-driven. In spite of the serious budget deficit that the federal government must address, and to some extent because of it, it is essential that Congress and the Executive branch embrace a robust federal role that supports the vision expressed in recent landmark reports, particularly, Mental Health: A Report of the Surgeon General (1999) and Achieving the Promise: Transforming Mental Health Care in America (2003), the final report of the President's New Freedom Commission on Mental Health.[1] The New Freedom Commission’s interim and final reports detailed the virtual collapse of the community mental health system and presaged an expansion of the federal role in "transforming" the mental health system to better serve mental health consumers and affected families. The Commission’s overarching recommendation -- that services and treatments for persons with psychiatric disabilities must be recovery-oriented and consumer-driven -- would require a new infusion of resources to make that promise a reality.
Background
Introduction
Mental Health America embraces the view articulated in 2002 by the President’s New Freedom Commission on Mental Health that this nation’s failure to make mental health a priority is a national tragedy. That tragedy manifests itself in many ways, of which the following data are illustrative:
- Mental disorders are implicated in 90 percent of the 30 thousand suicides and 650 thousand suicide attempts in this country each year;[1]
- 80 percent of the youth entering the juvenile justice system have a mental disorder;[2]
- Untreated and mistreated mental illness costs American business, government and taxpayers an estimated $113 billion annually.[3]
Americans have a stake, individually and collectively, in making mental health more of a priority. Communities across the country have taken steps to advance that goal, working to improve individual and family well-being and mental health in schools and health systems. Too often, however, communities have embraced that goal only partially, after experiencing a wrenching tragedy such as a youth’s suicide. Too often, the system failures and inadequacies that leave people without access to needed care are not perceived as critical public health issues. And too often, well-intentioned efforts fail to employ effective, state-of-the-art services and fail to provide culturally and linguistically competent services.
The impact of mental illness and mental health problems -- on individuals, families, communities, businesses, and taxpayers across the country –is enormous, and poses public-health challenges beyond the capacities of individual communities. As the New Freedom Commission’s report makes clear, governmental “mental health systems”and other "systems" that serve people affected by mental illness, local, state and federal, are badly fragmented and ill-equipped to address our nation’s mental health in a comprehensive, coordinated manner. Focusing primarily on the needs of those with the most severe mental illnesses and more generally on illness, rather than on public mental health, these systems have failed to keep pace with expanding needs and capacities for treatment. They have failed to serve the great majority of individuals who suffer significant but not catastrophic mental disorders. These failures have many causes and explanations. Among them are a lack of understanding that mental health is integral to all health; the widespread ignorance, fear, and stigma surrounding mental illness; and a legacy of laws and policies that discriminate against coverage of mental health conditions.
Mental disorders are implicated in 90 percent of the 30 thousand suicides and 650 thousand suicide attempts in this country each year;[4]
The Rationale for a Robust Federal Role
Many considerations –ranging from social justice to economic self-interest -- make it imperative that the federal government assume a major, focused, coordinated role in mental health policy, a role both different and larger than it currently plays. Among the many factors dictating a robust federal role is the extraordinary toll –in disability, productivity, and premature death –that mental illness takes in this country. Time after time, the federal government, armed with scientific tools, has responded aggressively to looming risks of disease endangering its citizens. In the 1960s, the federal government founded community mental health centers to begin to make community-based mental health treatment a reality. Expansion of Medicare and Medicaid coverage in the last 30 years increased coverage of some community mental health services. But both of those initiatives are spent, and a new federal role is needed.
For nearly 200 years, states have played a major role in the provision of mental health services. As the New Freedom Commission’s reports document so clearly, we now have a complex patchwork of services that provides vastly different types and levels of care for people in the various states. And the increasing budget pressures on states make it difficult for any state to re-tool current service structures, much less undertake leadership initiatives. Just as federal leadership was needed in the 1960’s to show the way toward community-based service systems rather than the longstanding reliance on asylums, federal leadership is needed today.
Advances in evidence-based mental health treatment now make it possible to offer people with mental illness a vision of recovery and to offer children with mental and emotional disorders a pathway to thrive in school and community. These visions are the origin of federal advocacy of what has come to be called "transformation." But true transformation requires more than rhetoric. We must find ways to provide support and treatment that enhance people’s own strengths and resiliency, rather than encouraging disability. We must improve people’s access to treatment and a choice of treatments responsive to their needs. Ensuring a path to recovery and increased resiliency will also require provision of a broad, comprehensive range of services and supports for individuals with the more severe illnesses or disabilities, ranging from supportive housing to psychosocial rehabilitation to supportive employment.[5] Our federal government has a rich history of ensuring its citizens equality of opportunity to achieve their potential, particularly in the face of discrimination or other societal barriers. We should not shrink from pressing the federal government to play that same critical role in fostering the recovery of those with serious mental illness, as well as in promoting mental health, fostering resiliency, and minimizing and containing the risk factors associated with the development of mental health and substance use disorders.
The Rationale for a Robust Federal Role
Many considerations –ranging from social justice to economic self-interest -- make it imperative that the federal government assume a major, focused, coordinated role in mental health policy, a role both different and larger than it currently plays. Among the many factors dictating a robust federal role is the extraordinary toll –in disability, productivity, and premature death –that mental illness takes in this country. Time after time, the federal government, armed with scientific tools, has responded aggressively to looming risks of disease endangering its citizens. In the 1960s, the federal government founded community mental health centers to begin to make community-based mental health treatment a reality. Expansion of Medicare and Medicaid coverage in the last 30 years increased coverage of some community mental health services. But both of those initiatives are spent, and a new federal role is needed.
For nearly 200 years, states have played a major role in the provision of mental health services. As the New Freedom Commission’s reports document so clearly, we now have a complex patchwork of services that provides vastly different types and levels of care for people in the various states. And the increasing budget pressures on states make it difficult for any state to re-tool current service structures, much less undertake leadership initiatives. Just as federal leadership was needed in the 1960’s to show the way toward community-based service systems rather than the longstanding reliance on asylums, federal leadership is needed today.
Advances in evidence-based mental health treatment now make it possible to offer people with mental illness a vision of recovery and to offer children with mental and emotional disorders a pathway to thrive in school and community. These visions are the origin of federal advocacy of what has come to be called "transformation." But true transformation requires more than rhetoric. We must find ways to provide support and treatment that enhance people’s own strengths and resiliency, rather than encouraging disability. We must improve people’s access to treatment and a choice of treatments responsive to their needs. Ensuring a path to recovery and increased resiliency will also require provision of a broad, comprehensive range of services and supports for individuals with the more severe illnesses or disabilities, ranging from supportive housing to psychosocial rehabilitation to supportive employment.[6] Our federal government has a rich history of ensuring its citizens equality of opportunity to achieve their potential, particularly in the face of discrimination or other societal barriers. We should not shrink from pressing the federal government to play that same critical role in fostering the recovery of those with serious mental illness, as well as in promoting mental health, fostering resiliency, and minimizing and containing the risk factors associated with the development of mental health and substance use disorders.
Effective Period
The Mental Health America Board of Directors approved this policy on June 11, 2006. It will remain in effect for five (5) years and is reviewed as required by the Mental Health America Public Policy Committee.Expiration: June 11, 2011 |
[1] Other important reports support a strong federal role in mental health. These include (1) SAMHSA recovery statement, 2006, (2)"Risk Factors for Suicide: Summary, " 2001, (3) Reducing Suicide: A National Imperative," 2002, (4) Institute of Medicine's report, "Improving the Quality of Health Care for Mental and Substance-use Conditions," 2005.
[2] “Reducing Suicide: A National Imperative,”Institute of Medicine, 2002.[3] Cocozza, J.J., and Skowyra, K. “Youth with mental disorders: Issues and emerging responses.”
Juvenile Justice Journal, 7(1), 3-13.
[4] Rice, P.D. and Miller, L.S., Health Economics and cost implications of anxiety and other mental disorders in the United States, British Journal of Psychiatry, 172(34), 4-9, 1998.
[5] The federal government has a long history of engagement in housing; rehabilitation; and workforce development, training and employment. But such programs and initiatives have not been shaped to meet the needs of people with chronic mental illnesses.
[6] The federal government has a long history of engagement in housing; rehabilitation; and workforce development, training and employment. But such programs and initiatives have not been shaped to meet the needs of people with chronic mental illnesses.
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