I do think your priorities sound great! However re: #6 and #7 --
Local Consumers are again expressing concern, as they did in the 1990's, about the dangers of the widespread use of technology and computer systems and data which seriously compromises their confidentiality.

They are organizing to advocate--but we don't have enough staff to support their efforts!
There are many examples of this problem, but here are 2 from my experience here at MHA/Maui.

Under Quality AND technology
1) A consumer who has been repeatedly turned away from our Maui Mental Health Center--had bad experiences with the way they were treated even trying to qualify and maybe at the assessment too (possibly had to go through Hawaii Disability Rights Ctr. to finally gain access--but were too mistrustful to go to our MH Center or talk with their staff--calls our crisis or ACCESSLINE (or I call for them because their homeless and suicidal) and they or I are told that they "refused services"--which simply means that they were trying to manage their anger with the last MH Center or ACCESSLINE staff who yelled at them and they quietly turned and walked aways (I have seen this and heard them being yelled at on our telephone).

2) An answer to a letter of complaint through the existing channels is copied to so many involved Depts. and State or State funded agencies that they will all know the family or person involved in their many community roles--even if their name is NOT mentioned in the reply to the letter. (We are a small State and a semi-rural islande and we all wear so many hats! It is important for our roles as advocates or as family members not to impact on our jobs, for example.)

I hope this consumer/family perspective with our Maui experience helps your planning.

I would like to see more money available for education/job training. People have to enroll for a certain number of hours to qualify for federal financial aid. Change this so that people can take fewer classes over longer periods of time. It seems to take five or ten years to recover from or cope with mental illness to the extent needed to be employed. If the person takes a class or two consistently through the recovery process, they are close to or have completed a degree and are ready to work. Likewise, if some schools offered trade classes for part of a day instead of for a full day, people with mental illness would be more likely to be successful.

On July 22, 2008 the Consumer-Survivor subcommittee of CMHS’s National Advisory Council unanimously adopted the following resolution I proposed: “Whereas the Consumer-Survivor Subcommittee believes that economic empowerment, self-sufficiency and security are crucial to the goals of recovery, full participation and integration in society and therefore to system transformation, we recommend to the Advisory Council that CMHS adopt these as explicit, central goals in its strategic and Presidential transition planning, Transformation initiative and all other polices, programs and practices relevant to adult mental health consumers.” Since the Council has only had one, very recent meeting since that time, I do not know if they have had a chance to consider adopting this recommendation of their subcommittee, but I strongly urge CMHS to adopt the essence of it as one of its strategic initiatives.

Persons with serious mental illness (those CMHS, of course, should be most concerned about) have the highest unemployment rate of any identifiable population (as high as 90% for those with Schizophrenia) and are among the poorest Americans, and getting poorer on average, year after year. Just a few days ago it was announced that for the second year in a row, there will be NO cost of living adjustment (COLA) for Social Security recipients, including SSDI and SSI recipients, which will only exacerbate the growing impoverishment. Psychiatric disability is the largest and fastest growing category of SSDI and SSI recipients and millions of “consumers” are on one or both of these programs.

Unless something dramatically changes, it is virtually inevitable that consumers will increasingly be unable to live, period, let alone well, in places like Montgomery county, where I live and where CMHS is headquartered, and indeed, in most of the country. This is because of the easily demonstrable reality that the income of most consumers simply does not keep up with the ACTUAL increased cost of living; hence they fall further behind year after year, even as needed services and supports are being cut. Even when there is an annual Social Security COLA, because of they way it is calculated, it fails to reflect the ACTUAL increased cost of living most consumers experience.

In my opinion significant poverty and the associated economic insecurity and dis-empowerment is not compatible with meaningful recovery, the promotion of which is ostensibly a - if not the - principle goal of CMHS. Empowerment is integral to any meaningful concept of recover and it is hard to imagine consumers feeling and being empowered in general if they are economically dis-empowered and insecure.

Moreover, the sort of poverty most consumers experience leads to some of the problems addressed by the CMHS initiatives, such as homelessness. Poverty, increasing over time, greatly constrains the possibilities for recovery and life in general - leading to severely limited choices in all aspects of life, isolation, inadequate or unsafe housing, factors that lead to ill health and many other difficulties and problems.

Therefore, I submit that focusing on helping real consumers become more economically secure and empowered - beyond just helping consumers achieve some employment - should be a central concern and priority of CMHS and therefore one of its strategic initiatives.

Randy Bosin

More than 1/4 - 1/3 of Social Security Disability Insurance and Supplemental Security Income (SSDI and SSI, respectively) are people with 'mental' disorders, according to some sources.

The amounts for SSI (this one is disability and NEEDS BASED) to save as assets, as an individual, has not increased by more than $500 in more than 36 years! So, an individual who has more than $2,000 of assets who is receiving SSI or many other programs, including Medical Assistance/Medicaid (NOT to be confused with Medicare) can never, by working, retain health insurance or cash benefits if over assets. (for a couple, the amount is $3,000)

There is NO incentive to work and try to remove self from disability rolls, or partially, given this ASSET RULE.

The system is basically creating dependency; less than 1% of individuals ever leave the disability rolls per year, given this scenario (that and the tying of health care and food and housing together... all dependent on tiny variations that could come from working.. or other life circumstances.) Basically, this system is part of the matrix of causes that have widened the gap over the decades over the 'haves' and 'have nots'. Individuals with mental illness overwhelmingly represent the 'have nots', on a number of levels.

Please SAMHSA, get involved with the reductionist, infantile, and short sighted federal policies that SSI, SSDI and many of these entitlements and needs based benefits are patch-worked with. Poverty, homelessness, and early death ... do we want to treat our most vulnerable this way?