President’s New Freedom Commission on Mental Health Report Overview

1. President’s New Freedom Commission on Mental Health Report Overview Pablo Hernandez, M.D.

2. 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

3. President’s New Freedom Initiative

4. The President’s New Freedom Commission on Mental Health • Achieving the Goal • Transforming Mental Health Care in America

5. 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

6. 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

7. 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

8. 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

9. 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

10. The President’s New Freedom Commission on Mental Health The 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

11. The President’s New Freedom Commission on Mental Health Goal 1 Americans Understand that Mental Health is Essential to Overall Health

12. The President’s New Freedom Commission on Mental Health Goal 2 Mental Health Care Is Consumer and Family Driven

13. 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.

14. 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.

15. 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.

16. 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.

17. 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 widelyavailable. • Address mental health problems in the criminal and juvenile justice systems.

18. The President’s New Freedom Commission on Mental Health Achieving the Goal: Recommendation 2.4 Create a Comprehensive State Mental Health Plan

19. The President’s New Freedom Commission on Mental Health Achieving the Goal: Recommendation 2.5 Protect and enhance consumer’s rights

20. 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

21. The President’s New Freedom Commission on Mental Health Goal 3 Disparities in Mental Health Services Are Eliminated

22. 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

23. The President’s New Freedom Commission on Mental Health Achieving the Goal: Recommendation 3.1 Improve access to quality care that is culturally competent.

24. 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.

25. The President’s New Freedom Commission on Mental Health Goal 4 Early Mental Health Screening, Assessment, and Referral to Services Are Common Practices

26. 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

27. The President’s New Freedom Commission on Mental Health Achieving the Goal: Recommendation 4.1 Promote the mental health of young children

28. 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

29. 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

30. 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

31. 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

32. The President’s New Freedom Commission on Mental Health Goal 5 Excellent Mental Health Care is Delivered and Research is Accelerated

33. 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

34. 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

35. 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

36. 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

37. The President’s New Freedom Commission on Mental Health Achieving the Goal: Recommendation 5.4 Develop the knowledge base in four understudied areas

38. 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

39. The President’s New Freedom Commission on Mental Health Goal 6 Technology is Used to Access Mental Health Care and Information

40. 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

41. 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

42. 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

43. 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.

44. 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

45. 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.

46. 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.

47. 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.

48. 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.

49. 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).

50. 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.