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By Jennifer Chase
In April 2002, while the country was still reeling from the previous
year's September 11 attacks and a war against Afghanistan, President
Bush made good on one of his election campaign promises.
Bush's "New Freedom Commission on Mental Health" was created to
eliminate inequality for Americans with disabilities. Its first
charge was to complete a comprehensive study of public and private
mental health service in the United States. It was the first such
study since President Carter's Mental Health Commission 25 years
ago.
The Commission's Interim Report, released in October 2002, declared
the existing system a "fragmented, inefficient maze of private,
federal, state and local government programs with scattered responsibility
for services that frustrates both people with mental disorders and
providers of mental health care," and called for reform at all levels
of the mental health system.
Its final report released this summer highlights the need for early
diagnosis in children, more timely appropriate care and perhaps
most importantly to area commissioners, individualized care that's
more family-centric. Several New England commissioners spoke to
Massachusetts Psychologist about how the report will change
their states and ways in which the states may have been ahead of
the report's time. At press time, representatives from the Massachusetts
and Rhode Island Departments of Mental Health had not returned phone
requests for interviews to be included in this article.
New Hampshire
"The report isn't going to drive us in any direction [but] will
validate what we're doing on the whole," says Geoffrey Souther,
acting director for New Hampshire Department of Behavioral Health.
"It's very confirming because many resources in the report we've
embraced already."
New Hampshire has already implemented some of the report's recommendations.
Along with more family-centric patient treatment like the Coalition
of Families through Mental Health and client-centered conferences
that treat mentally ill patients collaboratively, involving the
patient, guardian, and clinicians, New Hampshire will continue to
push evidence-based practices and technological advances. "New Hampshire
is trying to focus on technology; we've been trying for a long time
to find better ways to collect data," says Souther. "And evidence
based practices is where we must go....The commission does push
that."
Maine
"For us, the report came at an opportune time," says Sabra Burdick,
acting commissioner of Maine's Behavioral and Development Services.
Governor John Elias Baldacci created the Office of Health Policy
and named Trish Riley, national health policy expert, as director;
one of the office's roles will be to develop a health plan for Maine,
which will integrate mental health care.
"The more we integrate, the more we reduce stigma," says Burdick.
"Those of us who will be leading that part of the effort will use
the New Freedom Commission report ... as the foundation of our work."
As outlined in the report, Burdick says children's services are
on Maine's agenda. "We are partially funding and watching very closely
a Maine Medical Center study attempting to identify the possible
signs of schizophrenia before onset. Other similar studies are going
on in Europe and Australia. The results are promising. The newest
studies on bipolar disorder in children are alarming and I think
require all of our attention.
"Prevention and early intervention are key," she adds, "Parents
tell us that their primary care physicians are the first place they
turn to, the people they trust the most. They need to know more
about mental illness. Therefore, we are involved in a couple of
outreach efforts with doctors as leaders."
Connecticut
"The report reinforces a lot of the things we've been working on
- the focus on recovery and helping people find jobs, decent housing,
and qualified treatment ... as opposed to putting people under a
mental health umbrella," says Wayne Dailey, Ph.D., senior adviser
for Connecticut's Department of Mental Health and Addiction Services.
"We're building a value-driven, recovery oriented system of care
based on the governor's blueprint for recovery that has been reinforced
by the President's Commission.... It's more of an emphasis on treatment
as being a small but important part, rather than dominant part,
of successful treatment."
Dailey says Connecticut will implement programs that help the mentally
ill build connections with the community so that they may engage
in school, worship and education. "[Connecticut] wants to create
programs that assist with gainful employment for those who want
to work and wants to educate them and provide affordable housing
to create a life that is filled with the kinds of things all of
us desire."
On Oct. 10, Mike Hogan, Ph.D., chairperson of the President's New
Freedom Commission on Mental Health, met with the governor's staff
and committees of the human service agencies throughout Connecticut,
followed by a town meeting with some 300 legislators, community
members, consumers, advocates, providers, and family members of
mentally ill individuals. All discussion focused on the Commission's
report.
Vermont
"I think the report was excellent, and we're going to be using it
as a management tool to assess what we need to do in each area,"
says Susan Besio, Ph.D., commissioner of Vermont's Department of
Developmental and Mental Health Services. "The thing I liked most
about it was its emphasis on recovery. It recognizes that mental
illness is treatable."
Counselor and family-driven support is the key to quality services,
says Besio, and would be the main area in which Vermont will continue
to tweak its system according to report recommendations. With medical
homes already established that monitor patient physical and mental
health, as well as a pediatric collaborative where mental health
professionals and physicians work together, Besio believes Vermont
is "'on' in almost every way."
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