Tag: New Freedom Commission on Mental Health

What was TeenScreen?

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Introduction

The TeenScreen National Centre for Mental Health Checkups at Columbia University was a national mental health and suicide risk screening initiative for middle- and high-school age adolescents.

On 15 November 2012, according to its website, the programme was terminated. The organisation operated as a centre in the Division of Child and Adolescent Psychiatry Department at Columbia University, in New York City.

The programme was developed at Columbia University in 1999, and launched nationally in 2003. Screening was voluntary and offered through doctors’ offices, schools, clinics, juvenile justice facilities, and other youth-serving organisations and settings. As of August 2011, the programme had more than 2,000 active screening sites across 46 states in the United States, and in other countries including Australia, Brazil, India and New Zealand.

Screening Programme

Organisation

The programme was developed by a team of researchers at Columbia University, led by David Shaffer. The goal was to make researched and validated screening questionnaires available for voluntary identification of possible mental disorders and suicide risk in middle and high school students. The questionnaire they developed is known as the Columbia Suicide Screen, which entered into use in 1999, an early version of what is now the Columbia Health Screen. In 2003, the New Freedom Commission on Mental Health, created under the administration of George W. Bush, identified the TeenScreen program as a “model” programme and recommended adolescent mental health screening become common practice.

The organisation launched an initiative to provide voluntary mental health screening to all US teens in 2003. The following year, TeenScreen was included in the national Suicide Prevention Resource Centre’s (SPRC) list of evidence-based suicide prevention programmes. In 2007, it was included as an evidence-based programme in the US Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Registry of Evidence-based Programmes and Practices. In 2009, the organisation launched the TeenScreen Primary Care initiative to increase mental health screening by paediatricians and other primary care providers, the same year the US Preventive Services Task Force recommended annual adolescent mental health screening as part of routine primary care, and the Institute of Medicine recommended expansion of prevention and early identification programmes.

As of 2011, the programme was led by executive director Laurie Flynn, deputy executive director Leslie McGuire and scientific advisor Mark Olfson, M.D., alongside a National Advisory Council of healthcare professionals, educators and advocates.

As of 15 November 2012, TeenScreen has been terminated, will no longer train or register new programmes, and will cease all operations by the end of the year.

Mission and Locations

The mission of the TeenScreen National Centre was to expand and improve the early identification of mental health problems in youth. In particular, TeenScreen aimed to find young people at risk of suicide or developing mental health disorders so they could be referred for a comprehensive mental health evaluation by a health professional. The programme focuses on providing screening to young people in the 11-18 age range. From 2003 until 2012, the programme was offered nationally in schools, clinics, doctors’ offices and in youth service environments such as shelters and juvenile justice settings. As of August 2011, more than 2,000 primary care providers, schools and community-based sites in 46 states offered adolescent mental health screening through the TeenScreen National Centre. In addition, the screening was also being provided in other countries including Australia, Brazil, India, New Zealand and Scotland.

Screening Process

TeenScreen provided materials, training and technical help through its TeenScreen Primary Care and Schools and Communities programmes for primary care providers, schools and youth-serving organisations that provided mental health screening to adolescents. A toolkit was provided, including researched and validated questionnaires, instructions for administering, scoring and interpreting the screening responses. Primary care programme materials included information on primary care referrals for clinical evaluation. In the school and community setting, the screening process was voluntary and required active parental consent and participant assent prior to screening sessions.

The validated questionnaires included items about depression, thoughts of suicide and attempts, anxiety, and substance use. The screening questionnaires typically took up to ten minutes for an adolescent to complete. Once the responses to the questionnaire had been reviewed, any adolescent identified as being at possible risk for suicide or other mental health concerns would then assessed by a health or mental health professional. The result of this assessment determined whether the adolescent could be referred for mental health services. If this was the case, parents were involved and provided with help locating the appropriate mental health services.

Research, Endorsements and Responses

Recommendations and Research

Mental health screening has been endorsed by the former US Surgeon General David Satcher, who launched a “Call to Action” in 1999 encouraging the development and implementation of safe, effective school-based programmes offering intervention, help and support to young people with mental health issues. TeenScreen is included as an evidence-based programme in the US Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Registry of Evidence-based Programs and Practices as a scientifically tested and reviewed intervention. In addition, the US Preventive Services Task Force recommended in 2009 that mental health screening for teenagers be integrated into routine primary care appointments.

Studies have been conducted on the effectiveness and impact of mental health screening for young people. In a 2004 systematic evidence review, the US Preventive Services Task Force found that there were no studies that addressed whether screening as part of primary care reduced morbidity and mortality, nor any information of the potential risks of screening. In a later review, published in 2009, the task force found that there was evidence supporting the efficacy of screening tools in identifying teenagers at risk of suicide or mental health disorders.

A team of researchers from Columbia University and the New York State Psychiatric Institute completed a randomised controlled clinical trial on the impact of suicide screening on high school students in New York State from 2002-2004. The study found that students who were given a questionnaire about suicide were no more likely to report suicidal thoughts after the survey than students in the control group who had not been questioned. Neither was there any greater risk for “high risk” students. A subsequent study by the researchers, in 2009, found that screening appeared to increase the likelihood that adolescents would receive treatment if they were at risk for mental health disorders or suicide.

A study published in 2011, involving 2,500 high school students, examined the value of routine mental health screening in school to identify adolescents at-risk for mental illness, and to connect those adolescents with recommended follow-up care. The research, conducted between 2005 and 2009 at six public high schools in suburban Wisconsin, found that nearly three out of four high school students identified as being at-risk for having a mental health problem were not in treatment at the time of screening. Of those students identified as at-risk, a significant majority (76.3%) completed at least one visit with a mental health provider within 90 days of screening. More than half (56.3%) received minimally adequate treatment, defined as having three or more visits with a provider, or any number of visits if termination was agreed to by the provider.

A separate study published in 2011, found that mental health screening was effective at connecting African-American middle school students from a predominantly low-income area with school-based mental health services. Researchers have also found evidence to support the addition of mental health screenings for adolescents while undergoing routine physical examinations.

Acceptance and Critical Responses

Recommendations endorsing adolescent mental health screening have been issued by the Institute of Medicine (IOM) and the US Preventative Services Task Force (USPSTF). The American Academy of Paediatrics recommends assessment of mental health at primary care visits and suggests the use of validating screening instruments. These add to statements and recommendations to screen adolescents for mental illness from the American Medical Association (AMA), the Society for Adolescent Health and Medicine, the American Academy of Family Physicians and the National Association of Paediatric Nurse Practitioners. TeenScreen has been endorsed by a number of organizations, including the National Alliance for the Mentally Ill, and federal and state commissions such as the New Freedom Commission.

There is opposition to mental health screening programmes in general and TeenScreen in particular, from civil liberties, parental rights, and politically conservative groups. Much of the opposition is led by groups who claim that the organization is funded by the pharmaceutical industry; however, in 2011, an inquiry launched by Senator Charles E. Grassley into the funding of health advocacy groups by pharmaceutical, medical-device, and insurance companies demonstrated to Senator Grassley’s satisfaction that TeenScreen does not receive funding from the pharmaceutical industry. Senator Grassley sent a letter to TeenScreen and 33 other organisations like the American Cancer Society asking about their financial ties to the pharmaceutical industry. TeenScreen replied saying they did not accept money from medical companies.

In 2005, TeenScreen was criticised following media coverage of a suit filed a local screening programme in Indiana by the parents of a teenager who had taken part in screening. The suit alleged that the screening had taken place without parents’ permissions. The complaint led to a change in how parental consent was handled by TeenScreen sites. In 2006, the programme’s policy was amended so that active rather than passive consent was required from parents before screening adolescents in a school setting.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/TeenScreen >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Substance Abuse and Mental Health Services Administration?

Published on by Andrew Marshall1 Comment

Introduction

The Substance Abuse and Mental Health Services Administration (SAMHSA) is a branch of the US Department of Health and Human Services.

It is charged with improving the quality and availability of treatment and rehabilitative services in order to reduce illness, death, disability, and the cost to society resulting from substance abuse and mental illnesses. The Administrator of SAMHSA reports directly to the Secretary of the US Department of Health and Human Services. SAMHSA’s headquarters building is located outside of Rockville, Maryland.

Brief History

SAMHSA was established in 1992 by Congress as part of a reorganisation stemming from the abolition of Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA). ADAMHA had been established in 1973, combining the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH). The 1992 ADAMHA Reorganisation Act consolidated the treatment functions that were previously scattered amongst the NIMH, NIAAA, and NIDA into SAMHSA, established as an agency of the Public Health Service (PHS). NIMH, NIAAA, and NIDA continued with their research functions as agencies within the National Institutes of Health.

Congress directed SAMHSA to target effectively substance abuse and mental health services to the people most in need and to translate research in these areas more effectively and rapidly into the general health care system.

Charles Curie was SAMHSA’s Director until his resignation in May 2006. In December 2006 Terry Cline was appointed as SAMHSA’s Director. Dr. Cline served through August 2008. Rear Admiral Eric Broderick served as the Acting Director upon Dr. Cline’s departure, until the arrival of the succeeding Administrator, Pamela S. Hyde, J.D. in November 2009. She resigned in August 2015 and Kana Enomoto, M.A. served as Acting Director of SAMHSA until Dr. Elinore F. McCance-Katz was appointed as the inaugural Assistant Secretary for Mental Health and Substance Abuse. The title was changed by Section 6001 of the 21st Century Cures Act.

Organisation

SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on American’s communities.

Four SAMHSA offices, called Centres, administer competitive, formula, and block grant programs and data collection activities:

  • The Centre for Mental Health Services (CMHS) focuses on prevention and treatment of mental disorders.
  • The Centre for Substance Abuse Prevention (CSAP) seeks to reduce the abuse of illegal drugs, alcohol, and tobacco.
  • The Centre for Substance Abuse Treatment (CSAT) supports effective substance abuse treatment and recovery services.
  • The Centre for Behavioural Health Statistics and Quality (CBHSQ) collects, analyses, and publishes behaviour health data.

The Centres give grant and contracts to US states, territories, tribes, communities, and local organisations. They support the provision of quality behavioural-health services such as addiction-prevention, treatment, and recovery-support services through competitive Programmes of Regional and National Significance grants. Several staff offices support the Centres:

  • Office of the Administrator.
  • Office of Policy, Planning, and Innovation.
  • Office of Behavioural Health Equity.
  • Office of Financial Resources.
  • Office of Management, Technology, and Operations.
  • Office of Communications.
  • Office of Tribal Affairs and Policy.

Centre for Mental Health Services

The Centre for Mental Health Services (CMHS) is a unit of the Substance Abuse and Mental Health Services Administration (SAMHSA) within the US Department of Health and Human Services. This US government agency describes its role as:

The Center for Mental Health Services leads federal efforts to promote the prevention and treatment of mental disorders. Congress created CMHS to bring new hope to adults who have serious mental illness and children with emotional disorders.

As of March 2016, the director of CMHS is Paolo del Vecchio.

CMHS is the driving force behind the largest US children’s mental health initiative to date, which is focused on creating and sustaining systems of care. This initiative provides grants (now cooperative agreements) to States, political subdivisions of States, territories, Indian Tribes and tribal organisations to improve and expand their Systems Of Care to meet the needs of the focus population – children and adolescents with serious emotional, behavioural, or mental disorders. The Children’s Mental Health Initiative is the largest Federal commitment to children’s mental health to date, and through FY 2006, it has provided over $950 million to support SOC development in 126 communities.

Centre for Substance Abuse Prevention

The Centre for Substance Abuse Prevention (CSAP) aims to reduce the use of illegal substances and the abuse of legal ones.

CSAP promotes self-esteem and cultural pride as a way to reduce the attractiveness of drugs, advocates raising taxes as a way to discourage drinking alcohol by young people, develops alcohol and drug curricula, and funds research on alcohol and drug abuse prevention. CSAP encourages the use of ‘evidence-based programmes’ for drug and alcohol prevention. Evidence-based programmes are programmes that have been rigorously and scientifically evaluated to show effectiveness in reducing or preventing drug use.

Brief History and Legal Definition

CSAP was established in 1992 from the previous Office of Substance Abuse Prevention by the law called the ADAMHA Reorganisation Act. Defining regulations include those of Title 42.

Centre for Substance Abuse Treatment

The Centre for Substance Abuse Treatment (CSAT) was established in October 1992 with a Congressional mandate to expand the availability of effective treatment and recovery services for alcohol and drug problems. CSAT supports a variety of activities aimed at fulfilling its mission:

To improve the lives of individuals and families affected by alcohol and drug abuse by ensuring access to clinically sound, cost-effective addiction treatment that reduces the health and social costs to our communities and the nation.

CSAT works with States and community-based groups to improve and expand existing substance abuse treatment services under the Substance Abuse Prevention and Treatment Block Grant Programme. CSAT also supports SAMHSA’s free treatment referral service to link people with the community-based substance abuse services they need. Because no single treatment approach is effective for all persons, CSAT supports the nation’s effort to provide multiple treatment modalities, evaluate treatment effectiveness, and use evaluation results to enhance treatment and recovery approaches.

Centre for Behavioural Health Statistics and Quality

The Centre for Behavioural Health Statistics and Quality (CBHSQ) conducts data collection and research on ‘behavioural health statistics’ relating to mental health, addiction, substance use, and related epidemiology. CBHSQ is headed by a Director. Subunits of CBHSQ include:

  • Office of Programme Analysis and Coordination.
  • Division of Surveillance and Data Collection.
  • Division of Evaluation, Analysis and Quality.

Regional Offices

CMS has its headquarters outside of Rockville, Maryland with 10 regional offices located throughout the US:

  • Region I – Boston, Massachusetts:
    • Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island and Vermont.
  • Region II – New York, New York:
    • New York State, New Jersey, US Virgin Islands and Puerto Rico.
  • Region III – Philadelphia, Pennsylvania:
    • Delaware, Maryland, Pennsylvania, Virginia, West Virginia and the District of Columbia.
  • Region IV – Atlanta, Georgia:
    • Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee.
  • Region V – Chicago, Illinois:
    • Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin.
  • Region VI – Dallas, Texas:
    • Arkansas, Louisiana, New Mexico, Oklahoma and Texas.
  • Region VII – Kansas City, Missouri:
    • Iowa, Kansas, Missouri, and Nebraska.
  • Region VIII – Denver, Colorado:
    • Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming.
  • Region IX – San Francisco, California:
    • Arizona, California, Hawaii, Nevada, American Samoa, Guam, and the Northern Marina Islands.
  • Region X – Seattle, Washington:
    • Alaska, Idaho, Oregon, and Washington.

Strategic Direction

In 2010, SAMHSA identified 8 Strategic Initiatives to focus the Agency’s work. Below are the 8 areas and goals associated with each category:

  • Prevention of Substance Abuse and Mental Illness – Create prevention-prepared communities in which individuals, families, schools, workplaces, and communities take action to promote emotional health; and, to prevent and reduce mental illness, substance (including tobacco) abuse, and, suicide, across the lifespan
  • Trauma and Justice – Reduce the pervasive, harmful, and costly public-health impacts of violence and trauma by integrating trauma-informed approaches throughout health and behavioural healthcare systems; also, to divert people with substance-abuse and mental disorders away from criminal-/juvenile-justice systems, and into trauma-informed treatment and recovery.
  • Military Families – Active, Guard, Reserve, and Veteran – Support of our service men & women, and their families and communities, by leading efforts to ensure needed behavioural health services are accessible to them, and successful outcomes.
  • Health Reform – Broaden health coverage and the use of evidence-based practices to increase access to appropriate and high quality care; also, to reduce existing disparities between: the availability of substance abuse and mental disorders; and, those for other medical conditions.
  • Housing and Homelessness – To provide housing for, and to reduce the barriers to accessing recovery-sustaining programmes for, homeless persons with mental and substance abuse disorders (and their families)
  • Health Information Technology for Behavioural Health Providers – To ensure that the behavioural-health provider network – including prevention specialists and consumer providers – fully participate with the general healthcare delivery system, in the adoption of health information technology.
  • Data, Outcomes, and Quality – Demonstrating Results – Realise an integrated data strategy that informs policy, measures program impact, and results in improved quality of services and outcomes for individuals, families, and communities.
  • Public Awareness and Support – Increase understanding of mental and substance abuse prevention & treatment services, to achieve the full potential of prevention, and, to help people recognise and seek assistance for these health conditions with the same urgency as any other health condition.
  • Their budget for the Fiscal Year 2010 was about $3.6 billion. It was re-authorized for FY2011. Most recently, the FY 2016 Budget requests $3.7 billion for SAMHSA, an increase of $45 million above FY 2015.

Controversy

In February 2004, the administration was accused of requiring the name change of an Oregon mental health conference from “Suicide Prevention Among Gay/Lesbian/Bisexual/Transgender Individuals” to “Suicide Prevention in Vulnerable Populations.”

In 2002, then-President George W. Bush established the New Freedom Commission on Mental Health. The resulting report was intended to provide the foundation for the federal government’s Mental Health Services programmes. However, many experts and advocates were highly critical of its report, Achieving the Promise: Transforming Mental Health Care in America.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Substance_Abuse_and_Mental_Health_Services_Administration >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What was the New Freedom Commission on Mental Health?

Published on by Andrew Marshall3 Comments

Introduction

The New Freedom Commission on Mental Health was established by US President George W. Bush through Executive Order 13263 on 29 April 2002 to conduct a comprehensive study of the US mental health service delivery system and make recommendations based on its findings. The commission has been touted as part of his commitment to eliminate inequality for Americans with disabilities.

The President directed the Commission to identify policies that could be implemented by Federal, State and local governments to maximise the utility of existing resources, improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness and children with a serious emotional disturbance. The commission, using the Texas Medication Algorithm Project (TMAP) as a blueprint, subsequently recommended screening of American adults for possible mental illnesses, and children for emotional disturbances, thereby identifying those with suspected disabilities who could then be provided with support services and state-of-the-art treatment, often in the form of newer psychoactive drugs that entered the market in recent years.

A broad-based coalition of mental health consumers, families, providers, and advocates has supported the Commission process and recommendations, using the Commission’s findings as a launching point for recommending widespread reform of the nation’s mental health system.

A coalition of opponents questioned the motives of the commission, based on the results from a similar 1995 Texas mandate while Bush was Governor. During the Texas Medication Algorithm Project mandate, psychotropic medication was wrongfully prescribed to the general public. Specifically, TMAP and drug manufacturers marketed ‘atypical antipsychotic drugs’, such as Seroquel, Zyprexa, and others, for a wide variety of non-psychotic behaviour issues. These drugs were later found to cause increased rates of sudden death in patients.

In addition to atypical antipsychotic drugs, earlier versions of psychotropic medications, including Prozac, were found to sharply increase rates of suicide, especially during the first month of drug use. Also during TMAP, psychotropic medication was wrongfully prescribed to people not suffering from mental illness, including troublesome children and difficult elderly people in nursing homes. In 2009, Eli Lilly was found guilty of wrongfully marketing Zyprexa for non-psychotic people.

Opponents also assert the New Freedom initiative campaign is a thinly veiled proxy for the pharmaceutical industry to foster psychotropic medication on mentally healthy individuals in its pursuit of profits. Opponents also contend that the initiative’s wider objectives are to foster chemical behaviour control of American citizens, contrary to civil liberties and to basic human rights.

Reports

Interim Report

The commission issued an interim report on 01 November 2002. Findings in the report included estimated prevalence of severe mental illness among adults and severe emotional disturbance in children, the existence of effective treatments, and barriers to care.

Final Report

On 22 July 2003, the President’s commission returned a report containing nineteen formal recommendations, organised under six proposed national goals for mental health. The commission emphasised recovery from mental illness, calls for consumer and family-centred care, and recommendations that states develop a more comprehensive approach to mental health.

The commission reported that “despite their prevalence, mental disorders often go undiagnosed,” so it recommended comprehensive mental health screening for “consumers of all ages,” including preschool children, because “each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders.”

In contradiction, the Congressional Research Service, stated the commission did not specifically recommend a nationwide screening programme for mental illness, while it did discuss the need to identify mental illness in certain settings (juvenile detention facilities, foster care). The commission also recommended deeper study of the safety and effectiveness of medication use, especially among children.

Recommendations

Noting the country’s services for people with mental illness and disabilities were “fragmented,” the commission’s final report offered 19 recommendations within six larger goals to improve service coordination, move toward a recovery model, and help all individuals with mental illness and disability recover:

  • Americans Understand that Mental Health Is Essential to Overall Health.
    • Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention.
    • Address mental health with the same urgency as physical health.
  • Mental Health Care Is Consumer and Family Driven.
    • Develop an individualised plan of care for every adult with a serious mental illness and child with a serious emotional disturbance.
    • Involve consumers and families fully in orienting the mental health system toward recovery.
    • Align relevant Federal programmes to improve access and accountability for mental health services.
    • Create a Comprehensive State Mental Health Plan.
    • Protect and enhance the rights of people with mental illnesses.
  • Disparities in Mental Health Services Are Eliminated.
    • Improve access to quality care that is culturally competent.
    • Improve access to quality care in rural and geographically remote areas.
  • Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice.
    • Promote the mental health of young children.
    • Improve and expand school mental health programmes.
    • Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies.
    • Screen for mental disorders in primary health care, across the life span, and connect to treatment and supports.
  • Excellent Mental Health Care Is Delivered and Research Is Accelerated.
    • Accelerate research to promote recovery and resilience, and ultimately to cure and prevent mental illnesses.
    • Advance evidence-based practices using dissemination and demonstration projects and create a public–private partnership to guide their implementation.
    • Improve and expand the workforce providing evidence-based mental health services and supports.
    • Develop the knowledge base in four understudied areas: mental health disparities, long-term effects of medications, trauma, and acute care.
  • Technology Is Used to Access Mental Health Care and Information.
    • Use health technology and telehealth to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations.
    • Develop and implement integrated electronic health record and personal health information systems.

Opposition

Opponents of the plan see little in the way of potential benefits from the plan, except increased profits for pharmaceutical companies, and have concerns about the potential for unnecessarily causing neurological damage and contributing to increased substance abuse and drug dependence. Critics are also concerned by what they see as the pharmaceutical industry’s use of front organisations and the compromise of scientific integrity under colour of authority, look askance at the irony of the commission’s ‘freedom’ descriptor, contending the commission is yet another example of the excesses of drug industry marketing, and that the effects of its recommendations will simply foster drug use rather than the prevention of mental illness and use of alternative treatment modalities.

Screening Recommendations

Mad in America author Robert Whitaker criticized the commission’s screening recommendations as “fishing for customers.” A coalition of over 100 advocacy organisations, united under the banner of Mindfreedom.org in representing the psychiatric survivors movement, has been galvanised by their strong opposition to the New Freedom Commission. Using celebrity to advance their opposition, the MindFreedom coalition has again enlisted the support of long-time member and Gesundheit Institute founder Patch Adams, a medical doctor made famous by the movie that bears his name. Since 1992, Adams has supported MindFreedom campaigns, and in August, 2004, he kicked off the campaign against the New Freedom Commission by volunteering to screen President Bush himself. “He needs a lot of help. I’ll see him for free,” said Adams.

Others, including Congressman Ron Paul (R-TX14), were more concerned by the commission’s suggestion to use schools as a site for screening. Paul’s concern led to the introduction of H.R. 181 Parental Consent Act of 2005 in the US House of Representatives on 04 January 2005. The bill, which died in committee, would have forbidden federal funds from being used for any mental health screening of students without the express, written, voluntary, informed consent of parents. Paul introduced similar bills in May 2007 (H.R. 2387), April 2009 (H.R. 2218), and August 2011 (H.R. 2769); those, likewise, died in committee.

TMAP Origin Criticism

Critics also contend that the strategy behind the commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use.

TMAP, which was created in 1995 while President Bush was governor of Texas, began as an alliance of individuals from the University of Texas, the pharmaceutical industry, and the mental health and corrections systems of Texas. Through the guise of TMAP, critics contend, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in prisons and State psychiatric hospitals. The person primarily responsible for bringing these issues to the public’s attention is Allen Jones, a former investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations.

Jones wrote a lengthy report in which he stated that, behind the recommendations of the New Freedom Commission, was the “political/pharmaceutical alliance.” It was this alliance, according to Jones, which developed the Texas project, specifically to promote the use of newer, more expensive antipsychotics and antidepressants. He further claimed this alliance was “poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab.”

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/New_Freedom_Commission_on_Mental_Health >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What was Executive Order 13263?

Published on by Andrew Marshall1 Comment

Introduction

The New Freedom Commission on Mental Health was established by then-US President George W. Bush through Executive Order 13263 on 29 April 2002 to conduct a comprehensive study of the US mental health service delivery system and make recommendations based on its findings.

Executive Order 13316, signed on 17 September 2003, revoked Executive Order 13263.

Outline

President’s New Freedom Commission on Mental Health

By the authority vested in me as President by the Constitution and the laws of the United States of America, and to improve America’s mental health service delivery system for individuals with serious mental illness and children with serious emotional disturbances, it is hereby ordered as follows:

Section 1.⁠ Establishment.

There is hereby established the President’s New Freedom Commission on Mental Health (Commission).

Sec. 2.⁠ Membership.

(a) The Commission’s membership shall be composed of:

(i) Not more than fifteen members appointed by the President, including providers, payers, administrators, and consumers of mental health services and family members of consumers; and

(ii) Not more than seven ex officio members, four of whom shall be designated by the Secretary of Health and Human Services, and the remaining three of whom shall be designated—one each—by the Secretaries of the Departments of Labor, Education, and Veterans Affairs.

(b) The President shall designate a Chair from among the fifteen members of the Commission appointed by the President.

Sec. 3.⁠ Mission.

The mission of the Commission shall be to conduct a comprehensive study of the United States mental health service delivery system, including public and private sector providers, and to advise the President on methods of improving the system. The Commission’s goal shall be 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. In carrying out its mission, the Commission shall, at a minimum:

(a) Review the current quality and effectiveness of public and private providers and Federal, State, and local government involvement in the delivery of services to individuals with serious mental illnesses and children with serious emotional disturbances, and identify unmet needs and barriers to services.

(b) Identify innovative mental health treatments, services, and technologies that are demonstrably effective and can be widely replicated in different settings.

(c) Formulate policy options that could be implemented by public and private providers, and Federal, State, and local governments to integrate the use of effective treatments and services, improve coordination among service providers, and improve community integration for adults with serious mental illnesses and children with serious emotional disturbances.

Sec. 4.⁠ Principles.

In conducting its mission, the Commission shall adhere to the following principles:

(a) The Commission shall focus on the desired outcomes of mental health care, which are to attain each individual’s maximum level of employment, self-care, interpersonal relationships, and community participation;

(b) The Commission shall focus on community-level models of care that efficiently coordinate the multiple health and human service providers and public and private payers involved in mental health treatment and delivery of services;

(c) The Commission shall focus on those policies that maximize the utility of existing resources by increasing cost effectiveness and reducing unnecessary and burdensome regulatory barriers;

(d) The Commission shall consider how mental health research findings can be used most effectively to influence the delivery of services; and

(e) The Commission shall follow the principles of Federalism, and ensure that its recommendations promote innovation, flexibility, and accountability at all levels of government and respect the constitutional role of the States and Indian tribes.

Sec. 5.⁠ Administration.

(a) The Department of Health and Human Services, to the extent permitted by law, shall provide funding and administrative support for the Commission.

(b) To the extent funds are available and as authorized by law for persons serving intermittently in Government service (5 U.S.C. 5701-5707), members of the Commission appointed from among private citizens of the United States may be allowed travel expenses while engaged in the work of the Commission, including per diem in lieu of subsistence. All members of the Commission who are officers or employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States.

(c) The Commission shall have a staff headed by an Executive Director, who shall be selected by the President. To the extent permitted by law, office space, analytical support, and additional staff support for the Commission shall be provided by executive branch departments and agencies.

(d) Insofar as the Federal Advisory Committee Act, as amended, may apply to the Commission, any functions of the President under that Act, except for those in section 6 of that Act, shall be performed by the Department of Health and Human Services, in accordance with the guidelines that have been issued by the Administrator of General Services.

Sec. 6.⁠ Reports.

The Commission shall submit reports to the President as follows:

(a) Interim Report. Within 6 months from the date of this order, an interim report shall describe the extent of unmet needs and barriers to care within the mental health system and provide examples of community-based care models with success in coordination of services and providing desired outcomes.

(b) Final Report. The final report will set forth the Commission’s recommendations, in accordance with its mission as stated in section 3 of this order. The submission date shall be determined by the Chair in consultation with the President.

Sec. 7.⁠ Termination.

The Commission shall terminate 1 year from the date of this order, unless extended by the President prior to that date.

What was the New Freedom Commission on Mental Health?

Published on by Andrew Marshall1 Comment

Introduction

The New Freedom Commission on Mental Health was established by then-US President George W. Bush through Executive Order 13263 on 29 April 2002 to conduct a comprehensive study of the US mental health service delivery system and make recommendations based on its findings.

The commission has been touted as part of his commitment to eliminate inequality for Americans with disabilities.

The President directed the Commission to identify policies that could be implemented by Federal, State and local governments to maximise the utility of existing resources, improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness and children with a serious emotional disturbance. The commission, using the Texas Medication Algorithm Project (TMAP) as a blueprint, subsequently recommended screening of American adults for possible mental illnesses, and children for emotional disturbances, thereby identifying those with suspected disabilities who could then be provided with support services and state-of-the-art treatment, often in the form of newer psychoactive drugs that entered the market in recent years.

A broad-based coalition of mental health consumers, families, providers, and advocates has supported the Commission process and recommendations, using the Commission’s findings as a launching point for recommending widespread reform of the nation’s mental health system.

A coalition of opponents questioned the motives of the commission, based on the results from a similar 1995 Texas mandate while Bush was Governor. During the Texas Medication Algorithm Project mandate, psychotropic medication was wrongfully prescribed to the general public. Specifically, TMAP and drug manufacturers marketed ‘atypical antipsychotic drugs’, such as Seroquel, Zyprexa, and others, for a wide variety of non-psychotic behaviour issues. These drugs were later found to cause increased rates of sudden death in patients.

In addition to atypical antipsychotic drugs, earlier versions of psychotropic medications, including Prozac, were found to sharply increase rates of suicide, especially during the first month of drug use. Also during TMAP, psychotropic medication was wrongfully prescribed to people not suffering from mental illness, including troublesome children and difficult elderly people in nursing homes. In 2009, Eli Lilly was found guilty of wrongfully marketing Zyprexa for non-psychotic people.

Opponents also assert the New Freedom initiative campaign is a thinly veiled proxy for the pharmaceutical industry to foster psychotropic medication on mentally healthy individuals in its pursuit of profits. Opponents also contend that the initiative’s wider objectives are to foster chemical behaviour control of American citizens, contrary to civil liberties and to basic human rights.

Executive Order 13316, signed on 17 September 2003, revoked Executive Order 13263.

Reports

Interim Report

The commission issued an interim report on 01 November 2002. Findings in the report included estimated prevalence of severe mental illness among adults and severe emotional disturbance in children, the existence of effective treatments, and barriers to care.

Final Report

On 22 July 2003, the President’s commission returned a report containing nineteen formal recommendations, organised under six proposed national goals for mental health. The commission emphasised recovery from mental illness, calls for consumer and family-centred care, and recommendations that states develop a more comprehensive approach to mental health.

The commission reported that “despite their prevalence, mental disorders often go undiagnosed,” so it recommended comprehensive mental health screening for “consumers of all ages,” including preschool children, because “each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders.”

In contradiction, the Congressional Research Service, stated the commission did not specifically recommend a nationwide screening programme for mental illness, while it did discuss the need to identify mental illness in certain settings (juvenile detention facilities, foster care). The commission also recommended deeper study of the safety and effectiveness of medication use, especially among children.

Recommendations

Noting the country’s services for people with mental illness and disabilities were “fragmented,” the commission’s final report offered 19 recommendations within six larger goals to improve service coordination, move toward a recovery model, and help all individuals with mental illness and disability recover:

  1. Americans Understand that Mental Health Is Essential to Overall Health.
    • Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention.
    • Address mental health with the same urgency as physical health.
  2. Mental Health Care Is Consumer and Family Driven.
    • Develop an individualised plan of care for every adult with a serious mental illness and child with a serious emotional disturbance.
    • Involve consumers and families fully in orienting the mental health system toward recovery.
    • Align relevant Federal programmes to improve access and accountability for mental health services.
    • Create a Comprehensive State Mental Health Plan.
    • Protect and enhance the rights of people with mental illnesses.
  3. Disparities in Mental Health Services Are Eliminated.
    • Improve access to quality care that is culturally competent.
    • Improve access to quality care in rural and geographically remote areas.
  4. Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice.
    • Promote the mental health of young children.
    • Improve and expand school mental health programmes.
    • Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies.
    • Screen for mental disorders in primary health care, across the life span, and connect to treatment and supports.
  5. Excellent Mental Health Care Is Delivered and Research Is Accelerated.
    • Accelerate research to promote recovery and resilience, and ultimately to cure and prevent mental illnesses.
    • Advance evidence-based practices using dissemination and demonstration projects and create a public-private partnership to guide their implementation.
    • Improve and expand the workforce providing evidence-based mental health services and supports.
    • Develop the knowledge base in four understudied areas: mental health disparities, long-term effects of medications, trauma, and acute care.
  6. Technology Is Used to Access Mental Health Care and Information.
    • Use health technology and telehealth to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations.
    • Develop and implement integrated electronic health record and personal health information systems.

Opposition

Opponents of the plan see little in the way of potential benefits from the plan, except increased profits for pharmaceutical companies, and have concerns about the potential for unnecessarily causing neurological damage and contributing to increased substance abuse and drug dependence. Critics are also concerned by what they see as the pharmaceutical industry’s use of front organisations and the compromise of scientific integrity under colour of authority, look askance at the irony of the commission’s ‘freedom’ descriptor, contending the commission is yet another example of the excesses of drug industry marketing, and that the effects of its recommendations will simply foster drug use rather than the prevention of mental illness and use of alternative treatment modalities.

Screening Recommendations

Mad in America author Robert Whitaker criticised the commission’s screening recommendations as “fishing for customers.” A coalition of over 100 advocacy organisations, united under the banner of Mindfreedom.org in representing the psychiatric survivors movement, has been galvanized by their strong opposition to the New Freedom Commission. Using celebrity to advance their opposition, the MindFreedom coalition has again enlisted the support of long-time member and Gesundheit Institute founder Patch Adams, a medical doctor made famous by the movie that bears his name. Since 1992, Adams has supported MindFreedom campaigns, and in August, 2004, he kicked off the campaign against the New Freedom Commission by volunteering to screen President Bush himself. “He needs a lot of help. I’ll see him for free,” said Adams.

Others, including Congressman Ron Paul (R-TX14), were more concerned by the commission’s suggestion to use schools as a site for screening. Paul’s concern led to the introduction of H.R. 181 Parental Consent Act of 2005 in the US House of Representatives on 04 January 2005. The bill, which died in committee, would have forbidden federal funds from being used for any mental health screening of students without the express, written, voluntary, informed consent of parents. Paul introduced similar bills in May 2007 (H.R. 2387), April 2009 (H.R. 2218), and August 2011 (H.R. 2769); those, likewise, died in committee.

TMAP Origin Criticism

Critics also contend that the strategy behind the commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use.

TMAP, which was created in 1995 while President Bush was governor of Texas, began as an alliance of individuals from the University of Texas, the pharmaceutical industry, and the mental health and corrections systems of Texas. Through the guise of TMAP, critics contend, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in prisons and State psychiatric hospitals. The person primarily responsible for bringing these issues to the public’s attention is Allen Jones, a former investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations.

Jones wrote a lengthy report in which he stated that, behind the recommendations of the New Freedom Commission, was the “political/pharmaceutical alliance.” It was this alliance, according to Jones, which developed the Texas project, specifically to promote the use of newer, more expensive antipsychotics and antidepressants. He further claimed this alliance was “poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab.”