News Roundup [abridged Versions Appear In The Paper Journal]

Presidential commission urges revamp of US mental health system

BMJ 2003; 327 doi: (Published 31 July 2003) Cite this as: BMJ 2003;327:248
  1. Deborah Josefson
  1. Nebraska

    A drastic reorganisation of the mental healthcare system in the United States is needed, says the New Freedom Commission of Mental Health, a panel of 22 experts on mental health and social services.

    The commission was founded in April 2002 by a presidential directive, in a bid to eliminate inequality among US citizens with disabilities. President Bush asked the commission to identify problems in US mental healthcare and disability programmes and to suggest potential solutions.

    The commission drew on research, expert testimony, and input from over 2300 users, family members, and service providers.

    The resulting report found that the fragmentation of mental health services among several federal, state, local, and private agencies makes it extremely difficult for mentally ill people to get the coordinated care they need.

    “Services and treatments must be consumer and family centered, and not oriented to the requirements of bureaucracies,” the report says. “Care must focus on increasing consumers' ability to successfully cope with life's challenges, on facilitating recovery and on building resilience, not just on managing symptoms,” it continues.

    The panel found that mental illness affects almost every American family and that every year 5% to 7% of adults and 5% to 9% of children in the United States develop serious mental illness.

    Psychiatric illnesses are particularly ignored among very young people, elderly people, and people living in rural areas where access to health care is difficult, the report found. And mental illness is still stigmatised, which prevents many people from seeking help.

    Even if they receive treatment, the system is not organised to reintegrate patients into their communities and society, says the report. Rates of unemployment, homelessness, and imprisonment among mentally ill people are disproportionately high. These factors contribute to an estimated annual $79bn (£49bn; €69bn) in indirect costs attributed to mental illness, finds the report. Moreover, people with a mental illness are discouraged from working because they risk losing Medicaid and disability benefits. The system conspires to maintain disability, it says.

    The report calls for earlier detection and screening for mental illness, beginning in childhood, and for parity between mental health care and physical health care; the commission found that many health insurance plans limit their coverage for mental illness.

    The current significant time lag between the discovery of treatments for psychiatric ailments and their widespread clinical use needs to be shortened, recommends the report. It also calls for better use of existing technologies to identify mental healthcare information and improve access to it. The report does not, however, call for additional funds to rectify the deficiencies it highlights.

    Achieving the Promise: Transforming Mental Health Care in America is available at

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