A presidential commission issued a strong indictment Tuesday of the nation's mental health system, calling it "a patchwork relic" in need of "fundamental reform."
The "transformed" system envisioned by the New Freedom Commission on Mental Health would coordinate public eduction, medical treatment, job training, affordable housing and community support services to move the mentally ill toward full recovery.
"The time has long passed for yet another piecemeal approach to mental health reform," said commission chairman Michael F. Hogan, director of the Ohio Department of Mental Health. "This report provides the president with a road map for that transformation."
The report is less clear about how such changes would be paid for.
The federal official charged with developing a plan to implement the report's recommendations said the commission focused not on how much it would cost to treat and support the mentally ill but rather on how to use available resources "most wisely."
The key is to "put resources more in the hands of consumers and families," said Charles G. Curie, administrator of the Substance Abuse and Mental Health Services Administration.
When President Bush established the commission last year, he instructed its 22 members to identify gaps in the current mental health system and to recommend specific improvements. But his executive order also instructed the commission to recommend ways to use existing resources more efficiently. Mental health advocates welcomed the attention the commission focused on the problem and largely supported its recommendations. But a new report was not enough, they said.
"Policymakers have a choice," said Robert Bernstein, executive director of the Bazelon Center for Mental Health Law. "They can put this report on a shelf and continue the past policies of hopelessness, or they can act on its recommendations and make recovery-focused services a priority for millions of Americans with unmet mental health needs."
The commission released its report amid mounting evidence of the prevalence of serious mental illness in the United States -- and as public funding for mental health treatment is shrinking:
* A surgeon general's report issued in 1999 found that more than 50 million Americans -- roughly 1 in 5 -- suffered from mental illness but that fewer than half sought treatment.
* Express Scripts, a leading prescription-management company, has reported that antidepressants were the second most commonly prescribed class of drugs in 2000, and that usage increased almost 10% over the previous year.
* While the annual bill for mental health treatment totals more than $71 billion, according to the National Institutes of Mental Health, untreated mental illness costs the nation about $300 billion a year when criminal justice and social welfare expenses are included.
* In April, the National Center for Health Statistics reported that 1.6 million general-hospital discharges in 2001 were classified as psychosis cases. Psychosis ranked third among the discharge diagnoses; only heart disease and child deliveries numbered more.
* Among illnesses, mental illness is the leading cause of disability, according to the New Freedom Commission.
"Mental illnesses are shockingly common; they affect almost every American family," commission chairman Hogan said Tuesday in a cover letter to Bush.
In a given year, 5% to 7% of U.S. adults suffer a serious mental illness, the commission said, and 5% to 9% of children have a serious emotional disturbance.
The federal-state Medicaid program "is now the largest payer of mental health services in the country," accounting for roughly 20% of the nation's mental health bills, the panel reported. Federal, state and local government programs cover 57% of mental health treatment costs, while private funding -- health insurers, patients and families -- pays the rest.
But 29 states have cut mental health funding in the last year and 35 states expect to make new or additional cuts next year, according to the National Mental Health Assn.
The American Psychiatric Assn. noted Tuesday that "federal programs such as Medicare still discriminate against patients seeking treatment for mental disorders by limiting their care and forcing them to pay more for it."
Bush has called for an end to such policies. "Our health insurance system must treat mental illness like any other disease," he said last year on the day he created the New Freedom Commission. But federal legislation has not advanced that would require employers who provide mental health coverage to make its benefits equal to those for other illnesses, the psychiatrists and other mental health organizations noted Tuesday.
Although most lawmakers in the House and Senate have signed on as co-sponsors of the legislation, no action has been taken since spring, when the bills were referred to committees. The legislation is strongly opposed by insurance industry and employer groups.
The commission called for a comprehensive mental health system in the United States that would end the stigma often associated with mental illness and use public education campaigns, the Internet and primary-care physicians to help Americans recognize the symptoms of mental illness and tell them how to go about seeking treatment.
States would coordinate a network of services that, ideally, would provide patients with the equivalent of one-stop shopping. A case manager would work with an individual to develop a personalized care plan. In addition to medication, individual or group therapy or day-care treatment, the plan might also steer the person to subsidized housing, a job training program and substance-abuse counseling.
Curie said he would be working with several federal agencies to begin implementing the commission's recommendations. "Over the next two to three months we will begin phasing in some action," he said.
Richard Birkel, executive director of the National Alliance for the Mentally Ill, said that would be too long.
"We cannot wait another day, another year or another decade for real progress," he said. "Let today be the turning point. Let today begin the transformation of a broken system of care to one that provides recovery-oriented, community-based treatment and services that we know will work."