07/22/2003

Associated Press

WASHINGTON - Care for the mentally ill must go beyond medication and managing symptoms to help people find jobs, go on dates and live productive lives, a presidential commission said Tuesday in a report that recommended a major overhaul of the nation's mental health system.

The report said Americans must be taught that mental illness is not shameful so that people will seek out screening and treatment. It said innovative treatments and ideas must get into the field as they are proven effective; today, promising ideas can linger for 15 years or more before moving into routine practice.

"The commission recommends fundamentally transforming how mental health care is delivered in America," said the final report of the President's New Freedom Commission on Mental Health. "Although barriers stand in the way, with national resolve and leadership, they will be overcome."

The report was praised by an array of mental health advocates, who promised to lobby state and federal policy makers to implement its findings.

Health and Human Services Secretary Tommy Thompson called the report thorough and thoughtful and directed HHS' Substance Abuse and Mental Health Services Administration to review its recommendations.

The report is the second major look at mental health in the United States in recent years. In 1999, then-Surgeon General David Satcher issued an exhaustive review of research on mental disorders and concluded that shame and trouble paying for care kept millions from effective treatment.

Little about the nation's mental health system has changed since then, and the commission cites stigma surrounding mental illness as a major barrier to treatment.

About 5 percent to 7 percent of adults in the United States have serious mental illness, the commission said, and a similar portion of American children suffer from serious emotional disturbance.

Two in three mentally ill adults are unemployed, and more than half have incomes of less than $10,000 per year, according to a national survey released Tuesday by NAMI, a leading advocacy group for the mentally ill. The survey of more than 3,400 people with mental illness also found nearly two in three have never been married, and more than 40 percent had been detained or arrested for minor offenses.

It shows much work remains, said Richard Birkel, NAMI's national executive director. He said the commission's report could mark a turning point if its recommendations were implemented.

"Let today begin the transformation of a broken system of care to one that provides recovery-oriented, community-based treatment and services that we know will work," Birkel said.

The presidential commission, which President Bush created in April 2002, recommended that each state develop a comprehensive plan for transforming its system of care for the mentally ill. Those systems typically combine institutional and community care and are paid for with combinations of state, federal and private money.

The report does not recommend spending any new money, but says states should be given more flexibility in using dollars already available through various federal programs if they were to develop strong plans.

Today's mental health system, critics say, responds to crises, simply keeping people on medications and squelching symptoms. Under a new model, counselors would develop a plan to help the patient live a fuller life, which would include, but not be limited to, medication. That could mean helping someone find housing, get job training or develop skills to have social or romantic relationships.

There is little of that offered to most mentally ill patients, said Dr. Carl Bell, president of Chicago-based Community Mental Health Council.

"If you have someone who is schizophrenic, you diagnose them accurately and give them the medication. Your job is done," he said, describing typical practice. "It keeps a lot of people out of the hospital, keeps a lot of people from committing suicide, and it allows them to function at minimal levels. It's essential but not sufficient."

He said his centers offer comprehensive housing, job training and social services to help people live more normal lives. For instance, counselors might help someone figure out what to do if he hears voices while on a date.

"We teach them how to talk, how to hold conversations, how to not be anxious," Bell said.

Part of the problem is insurance companies are reluctant to pay for these services, said Dr. Robert Roca, medical director of the Sheppard Pratt Health System outside Baltimore. Fixing it will be costly, Roca said, and that won't be easy: "Mental health is not a high priority."

In its report, the commission also recommended that:

- Special educational attention be directed at rural Americans, racial and ethnic minorities and people whose primary language is not English.

- Consumer rights be recognized and respected and seclusion and restraint used only as a last resort, not as a standard treatment.

- Children be routinely screened for mental disorders in hopes of catching and treating them early.