Mental health and mental illness
I write this editorial as a follow-up to the most recent editorial in Archives (“Promises, Promises”) by our Editor, Judith Krauss (2004). Judy’s previous editorial focused on “recovery” as it is outlined in The New Freedom Commission on Mental Health and the role that relationships play in the generation of hope in the pathway to healing and recovery. My emphasis in the present editorial is on “advocacy” and the need for us, as mental health providers, to ensure that the “transformation of the mental health system”—as recommended by the Commission—be heard this time. Judy requested that all of our readers go to the web site to download the full report and read it if you have not already done so. I second this request.
During his 2000 presidential campaign, George W. Bush pledged that if he were elected, he would create a commission to conduct a comprehensive review of the care of people with mental illness. Such an examination would be the first to be undertaken in almost 25 years—which was during the Carter Administration. In April of 2002, in fulfillment of this pledge, Bush announced the creation of the President’s New Commission on Mental Health. The goal of the Commission was to “recommend improvements to enable adults with serious mental illness and children with serious emotional disturbances to live, work, learn, and participate fully in their communities.” (Executive Order, 2002). Dr. Michael Hogan, Ohio’s mental health director, chaired the Commission and issued the final report. Important here is that, in the final report, the Commission did not explicitly recommend the investment of any new moneys to finance the transformation for which it called.
The Commission put forth 19 recommendations linked to six goals as already outlined by Krauss (2004). In his report Dr. Hogan (2003) emphasized that the United States should fundamentally transform its system for treating people with mental illness. The report described the present mental health system as being fragmented and currently insufficient for delivery of mental health services. Such information is not news to those of us who are mental health providers; however it is more than significant that this information was requested and supported by the President of the United States.
The six goals of the Commission describe an ideal mental health system that is a far cry from the current system as we know it. However, Washington, D.C. is driven by priorities that are deemed more pressing than the Hogan report. It is not surprising, therefore, that the report has generated only limited interest outside the field of mental health care. And we must remember what happened with the last Commission on Mental Health created by President Jimmy Carter in 1977 (1978). The Carter Commission on Mental Health had proposed an ambitious agenda for reform, but before its major recommendations could be implemented, they fell victim to the dramatically different attitude toward the role of government in the provision of human services that Ronald Reagan brought to the White House in 1981. The Mental Health Systems Act of 1978, the centerpiece of the recommendations of the Carter Commission, was repealed by the Omnibus Budget Reconciliation Act of 1981, which contained the first round of budget reductions proposed by the Reagan administration and enacted by Congress (Iglehart, 2004).
The good news is that the mental health community mobilized quickly after the release of Dr. Hogan’s report. Putting aside parochial interests that have often divided advocates for people with mental illness, four organizations—The Bazelon Center for Mental Health Law, the National Alliance for the Mentally III, the National Association of State Mental Health Program Directors, and the National Mental Health Association—came together to create the Campaign for Mental Health Reform. Nine other organizations quickly joined the campaign.
Bottom line is that it is now up to us, the mental health providers. The specific findings of this landmark report strongly resonate many of the themes that consumers, families, and mental health providers have been advocating for the past several years. The report gives us a platform to drive a public policy advocacy message through to audiences in the legislature and media. We are at a convergence of opportunity. We have need and we have the most potent advocacy document since the Surgeon General’s Report on Mental Health released in 1999. These documents provide us with the tools to take the next critical step as the most influential mental health care provider, i.e., nurses, in contact with individuals with mental illness. We can assure that the call for transformation of the mental health system is heard this time. Be sure to telephone, write, or email your political representatives about this issue.
Tags: mental health