Advocates hope report stems mental health crisis. (President's New Freedom Commission).
The first effort of its kind in decades, the President's New Freedom Commission on Mental Health met April 3 for the last of 10 public sessions to discuss a final outline of the report, which was due to the White House by the end of April.
"[The commission] puts mental health policy on the national stage," said Andrew Hyman, director of government relations at the National Association of State Mental Health Program Directors. "It's been a very honest process."
Mental health supporters warned that the report, mandated by an executive order by President Bush last year, would only be as effective as the politicians who look to it for guidance.
"It could be just another report gathering dust, or it could be a blueprint for change. That depends on the political will for the White House," said Michael Zamore, policy adviser for Rep. Patrick Kennedy (D-R.I.), a leading congressional supporter for mental health.
In a development seen as hopeful to advocates, commissioners agreed at the April meeting to include support in the final report for a bill requiring mental health parity for private insurance companies. That bill, recently named the Senator Paul Well-stone Mental Health Equitable Treatment Act of 2003, has yet to be acted upon by the Senate Committee on Health, Education, Labor, and Pensions, but it has wide support from Congress and tacit support from the White House.
"The commission has really made progress," said Cordon Raley, vice president for federal partnerships at the National Mental Health Association. "The commissioners have taken a broad mental health view."
Disappointing some advocates was the commission's tendency to avoid discussion of the budget, an area in which advocates have long felt that mental health receives short shrift, in its deliberations.
"It doesn't make sense to look at reforming our mental health systems in a vacuum of budget neutrality," Mr. Zamore said. "While it's safe to say more money will not solve the problems in mental health care, it's also fanciful to imagine that we can bring about fundamental reform without addressing the question of resources."
In a November news release last year, the American Psychiatric Association criticized the commission on the same score, saying that advising the president with only budget-neutral methods to improve the system "has unreasonably limited its examination."
But commissioner Dr. Anil Godbole, chairman of Chicago's Advocate Illinois Masonic Medical Center, pointed out that a series of issue papers on various topics--evidence-based practices, co-occurring diseases, and older adults--will come out as they are completed by the commission, and that these may include specific policy recommendations that may require new money from congress.
Commissioners discussed the outline of the final report at the April meeting, agreeing to lead the document with recommendations on a national strategy on suicide prevention and a campaign aimed at reducing the stigma of mental health.
The final report as submitted to the White House--which then probably will make changes before releasing the document--will also include a recommendation to launch a national effort to focus on the mental health needs of young children.
"What we've said here is, 'Let's jump on this early'" commission chair Michael Hogan, Ph.D., said at the April meeting.
Dr. Hogan is the director of the Ohio Department of Mental Health.
Another recommendation, as written in a draft outline distributed at the April meeting, was to direct states to ensure that patients with mental illness each receive "a single individualized plan of care."
"This is a key goal for reducing fragmentation of the system," said Richard Nakamura, Ph.D., deputy director of the National Institute of Mental Health, Bethesda, Md.
A well-appreciated aspect of the commission was its diverse and decidedly outside-the-Beltway membership. "These weren't just the usual suspects," Dr. Godbole said. Included on the panel were local mental health coordinators, psychiatrists, psychologists, two state mental health directors, and one judge.
Visiting the commission over the last year were a wide variety of constituency groups, including children's experts, representatives from top professional societies, and hospital leaders. "The issues we address are shared by a 15-person panel," said Stephen Mayberg, Ph.D., director of the California Department of Mental Health. "The array of presenters was very diverse--it wasn't just mental health experts--housing employment experts, academics. Mental health services per se is not just treatment, it's treatment and support and peer support, coordinated services with other entities."
Mental health advocates pledged to try to use the final report to push for reforms on Capitol Hill.
"The American Psychiatric Association will take a hard look at the final report, as released by the president, to see what we can take to Capitol Hill and move legislatively," said APA deputy director Michael Strazzella.
As specified in the order creating the commission last year, after the final report appears, the commission will no longer meet.
Underscoring the need for improved public policy on mental health treatment, a mental health professional from Lincoln, Neb., appeared at the April meeting to deliver a desperate plea for help.
Two days before the meeting, the Richard Young Center in Omaha, about 1 hour from Lincoln, closed its doors after 73 years and millions of dollars in losses. The closing will send patients to BryanLGH Medical Center in Lincoln, despite a key complication.
"Our beds have been full all year," said David Miers, coordinator of BryanLGH's mental health services.