On November 1, the New Freedom Commission on Mental Health released its interim report to President George W. Bush. Commission Chairman Michael F. Hogan, PhD, called the mental health system “an inefficient maze of private, federal, state, and local government programs with scattered responsibility for services that frustrates both people with mental illnesses and providers of care.” Citing the need for dramatic reform on all levels, Dr. Hogan, Director of the Department of Mental Health for Ohio, announced, “the commission’s challenge now is to identify realistic solutions to help people with mental illnesses get the quality care that research has shown to be effective.”

The President’s New Freedom Commission on Mental Health was established by Executive Order on April 29, 2002. The President tasked the commission to recommend improvements in the United States’ mental health service system for adults with serious mental illness and for children with serious emotional disturbance. He requested a review of public and private sectors to identify policies that could be implemented by federal, state, and local governments to maximize the utility of existing resources, improve coordination of treatments and services, and promote a full life in the community for people with mental illness.

In its report, the commission determined that the system is not oriented to the “single most important goal” of the people it serves—the hope of recovery. “Many more individuals could recover—even from the most serious mental illnesses—if they had access to effective treatments tailored to their needs, to supports and services in their communities,” Dr. Hogan said.

The commission identified barriers to such quality care and recovery. Failure to make mental health “a national priority” was faulted, as were fragmentation and gaps in care for children, adults, and older adults. Chief blame, however, was laid on a system that “rewards dependency through a mix of inadequate rehabilitation and disincentives to work.”

“We need to answer the question, Why are 90% of adults with serious mental illnesses unemployed?” challenged Dr. Hogan. “Studies show that a majority want to work and can work. Instead, our nation's largest ‘program’ for people with mental illnesses is the disability system,” he added, noting that adults with mental illness are the largest and fastest-growing group of people with disabilities receiving Supplemental Security Income and Social Security Disability Income payments.

An estimated $25 billion is spent annually for this population. In its next phase of work, the commission will address ways to break down these barriers to recovery. According to Dr. Hogan, it has already identified some creative, community-based programs that blend the promise of modern science with the compassion of skilled professionals. Such exemplary programs as school-based mental health care, home visits by trained nurses for high-risk women during pregnancy and the first year of their child’s life, a program for suicide prevention, and effective treatments for late-life depression were lauded in the interim report. “These models can inspire communities nationwide and provide realistic examples of how quality, coordinated care is possible for millions of Americans with mental illness,” Dr. Hogan said. The commission’s recommendations will be presented in its final report.

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