(Part 1)

Marking a milestone in the history of mental health and mental illness in America, SAMHSA recently released Transforming Mental Health Care in America—The Federal Action Agenda: First Steps.

"As we mark the 15th anniversary of the Americans with Disabilities Act, the Action Agenda makes an important contribution for Americans with mental health-related disabilities," said Mike Leavitt, U.S. Secretary of Health and Human Services (HHS).

"The Action Agenda details the initial steps the Federal Government is taking to transform the form and function of the mental health service delivery system in America," said Secretary Leavitt. "HHS and its partners across the Federal Government are committed to a shared goal of collaborating to change fundamentally the way the Nation's mental health care system functions."

SAMHSA led the Action Agenda's development. The Agency aligned six cabinet-level departments—Education, Health and Human Services, Housing and Urban Development, Justice, Labor, Veterans Affairs, and the Social Security Administration—in an unprecedented multi-year effort, which includes more than 20 Federal agencies to carry out the 70 specific steps of the Action Agenda.

In addition, a Federal Executive Steering Committee was announced to guide the work of mental health system transformation.

The Action Agenda represents the very first "to do" list in the Federal response to Executive Order 13263, which launched President Bush's New Freedom Commission on Mental Health in 2002. The Commission's final report, Achieving the Promise: Transforming Mental Health Care in America, released in July 2003, found the Nation's mental health system "fragmented and in disarray." In that report, the Commission called for a complete transformation of the mental health service system. (See SAMHSA News, Volume 11, Number 3.)

The Action Agenda builds on the Commission's recommendations with a clear plan to redirect the mental health system to its primary goal: To help adults with serious mental illnesses and children with serious emotional disturbances achieve recovery—to be able to live, work, learn, and participate fully in their communities.

"The Action Agenda is a living document that begins to chart the course for long-term change," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "It is not a ‘quick fix' for the problems that have ailed the mental health care system for decades."

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Recovery Is Key

The foundation of the Action Agenda rests on the principle that recovery from mental illness is the expectation, not the exception.

"We are counting on consumers and family members to play a meaningful role," said SAMHSA's Center for Mental Health Services Director A. Kathryn Power, M.Ed. "In a transformed mental health system, services and treatments are consumer- and family-centered. Furthermore, care must focus on increasing an individual's ability to cope successfully with life's challenges, on building resilience—not just on managing symptoms—and on facilitating recovery."

The New Freedom Commission's final report offered good news: Adults with serious mental illnesses and children with serious emotional disturbances can and do recover. But Ms. Power continued, "Success means a system grounded in recovery and resilience, one that demonstrates a commitment to providing recovery-based services, and one that—through its actions—inspires hope for families and consumers alike."

Yet across the United States, many people with mental illness remain untreated. They struggle with an illness that affects their minds, their feelings, and their relationships with others. Approximately 19.6 million adults age 18 or older (9.2 percent) in the United States have a serious mental illness, according to SAMHSA's National Survey on Drug Use and Health. A similar percentage of children, about 5 percent to 9 percent, have a serious mental health problem.

"The reason for the Action Agenda is simple," Mr. Curie continued. "People with mental disorders have a vital role to play. Their ability to participate fully can no longer be derailed by outdated science, outmoded financing systems, and unspoken discrimination. Putting people with mental disorders at the heart of the health care system can be accomplished through the steps outlined in this Action Agenda," he said.

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The Basics

The Action Agenda presents the transformation process in four parts: principles, success markers, action steps, and current Federal activities. This simple format provides all the information required to follow the Federal Government's plan for mental health system transformation.

The Action Agenda is organized around the five Principles set forth in the President's 2002 Executive Order establishing the Commission:

Principle A: Focus on the outcomes of mental health care, including employment, self-care, interpersonal relationships, and community participation.

Principle B: Focus on community-level models of care that coordinate multiple mental health and human service providers and private and public payers.

Principle C: Maximize existing resources by increasing cost-effectiveness and reducing unnecessary and burdensome regulatory barriers.

Principle D: Use mental health research findings to influence the delivery of services.

Principle E: Ensure innovation, flexibility, and accountability at all levels of government and respect the constitutional role of the states and Indian tribes.

A "State of Success" follows each Principle with a list of specific achievements that, as they are accomplished, will herald a transformed mental health system.

Action steps for each Principle will move the mental health service system toward transformation.

Current activities in progress for each Principle are included in the Action Agenda. SAMHSA has completed an inventory of current, relevant Federal activities that respond to the Commission's vision.

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Action Agenda Components

The Action Agenda presents a simple plan to carry out the "to do" list-the five Principles set forth in Executive Order 13263, which established the President's New Freedom Commission on Mental Health in 2002. The following diagram illustrates the components of the Action Agenda:

Each Principle represents a specific task. To complete that task or Principle, detailed Action Steps are outlined for specific Government agencies and Current Activities under way are compiled. These efforts contribute to a State of Success and a transformed mental health system.

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Doing the Work

The public sector is the major financial driver in mental health care. Transformation is, however, "a shared responsibility," according to Mr. Curie. Federal agencies can act as leaders and as facilitators, promoting shared responsibility for change at the Federal, state, and local levels, and in the private sector, in such areas as public education, research, service system capacity, and technology development.

States, however, will be the very center of system transformation. Many states have already begun this critical work. Their leadership in planning, financing, service delivery, and evaluation of consumer and family-driven services will significantly advance mental health transformation.

Furthermore, SAMHSA's Mental Health Transformation State Incentive Grants are a key component of mental health system transformation. This grant program is unique in taking a "big picture" approach to improving service delivery. The focus is on state infrastructure—what a state puts into place to coordinate mental health planning, financing, services, and evaluations conducted by multiple systems to facilitate recovery and promote resilience for individuals and families coping with mental illnesses.

The grants provide seed money for the states to use to make systemic changes based on each state's vision of a comprehensive mental health system. SAMHSA has awarded grants totaling nearly $19 million to Ohio, Oklahoma, Washington, Maryland, New Mexico, and Texas.

A new Web page of state activities is now available, sponsored by SAMHSA through the National Association of State Mental Health Program Directors (NASMHPD). (See Web Resources in Part 2 of this article.)

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Action Agenda Highlights

• Reinforce the message that mental illnesses and emotional disturbances are treatable and that recovery is the expectation.

• Act immediately to reduce the number of suicides in the Nation through implementation of the National Strategy for Suicide Prevention, launched by the U.S. Department of Health and Human Services in 2001.

• Help states develop the infrastructure necessary to formulate and activate comprehensive state mental health plans that include the capacity to create individualized plans of care that promote resilience and recovery.

• Develop a plan to promote a mental health workforce better qualified to practice mental health care that is culturally sensitive and based on evidence-based practices in both specialty settings and at the primary care level.

• Initiate a national effort focused on the mental health needs of children and promote early intervention with informed parental consent for children identified to be at risk for mental disorders. Prevention and early intervention can help forestall or prevent disease and disability.

• Improve the interface of primary care and mental health services.

• Expand the Science-to-Services agenda to develop new toolkits outlining evidence-based practices for use by providers, administrators, educators, and consumers.

• Increase the employment of people with psychiatric disabilities.

• Design and initiate an electronic health records and information system that will help providers and consumers better manage mental health care and that will protect the privacy and confidentiality of each consumer's health information.

See Also-Article Continued: Part 2 »

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