7: No. 1, January 2010
ROUNDTABLE ON MENTAL HEALTH
Ensuring the Nation’s Mental Health: The Role of Federal Agencies
A. Kathryn Power, MEd
Suggested citation for this article: Power AK. Ensuring
the nation's mental health: the role of federal agencies. Prev Chronic Dis
jan/09_0128.htm. Accessed [date].
care, which addresses mental health and substance use, has been
neglected by our health care system. People with severe mental illnesses
and other chronic conditions such as diabetes, asthma, heart disease,
and obesity, die earlier than do people without such conditions. Behavioral health
conditions may not be properly addressed because of a lack of
community resources and poor health insurance coverage for such conditions. The federal government — in partnership with states, communities,
consumers, families, and the private sector — has responded with proposals for
health care reform that include mental health care.
In 2009, federal agency partners helped frame the agenda for health
care reform. Their focus was on creating a holistic, person-centered health
care system, achieved through a public health model that addresses the broad
determinants of health and mental health. In particular, they focused on
prevention, early intervention, and the use of technology to increase access
to and quality of health and mental health services.
The federal response to behavioral health care reform has been guided by 3 seminal documents that have influenced and reflected change in mental health systems and services. Reports by the Surgeon General (1), New Freedom Commission on Mental Health (2), and Institute of Medicine (3) made
all of the following clear:
- Mental health is essential to overall health.
- Mental illnesses are real disorders and treatment is effective.
- Recovery is the expected outcome of treatment and services.
- Services must be consumer- and family-driven and evidence-based.
Soon after the release of the New Freedom Commission’s final report in
2003, the US Department of Health and Human Services (HHS) charged its Substance Abuse and Mental Health Services Administration (SAMHSA) with leading efforts to transform the mental health system in this country. SAMHSA organized a collaborative effort among more than 20 federal
agencies and offices to ensure that people with mental and substance use disorders have every opportunity for recovery. Along with other agencies and offices in HHS, the federal partners include the US departments of agriculture, defense, education, housing and urban development, justice, labor, transportation, and veterans affairs, as
well as the Social Security Administration and the Equal Employment Opportunity Commission. The federal partners are guided in their work by the Federal Executive Steering Committee, a group of assistant secretary-level professionals who
ensure that resources will be available and promised actions will occur.
Efforts to improve systems of care for people with mental illnesses have been
extensive. Together, SAMHSA and its federal partners developed a specific agenda to create consumer-centered, recovery-focused, evidence-based, quality-driven systems of care for people with mental health problems. Transforming Mental Health Care in America: The Federal Action Agenda:
First Steps (4), released in 2005, and Transforming Mental Health Care
in America: The Federal Action Agenda: "A Living Agenda" (5), published in 2008, chart a vision for a transformed mental health system, delineate specific objectives to achieve
this vision, and highlight progress made.
The Federal Executive Steering Committee has focused on critical issues to ensure both full community integration for people with mental health problems and broad recognition of the role of mental health in overall health.
Some of these issues are countering the social exclusion of people with mental
illnesses through public education, preventing suicide, and increasing
employment opportunities for people with psychiatric disabilities, mental
illnesses, and emotional disturbances. Efforts to expand the reach of care
include collaborating with the criminal and juvenile justice systems to provide
access to mental health care, addressing the mental health needs of marginalized
groups such as refugees and homeless people, and improving mental health care
services for children and adolescents.
Research is needed to understand concurrent mental and physical disorders, develop new medications, promote evidence-based mental health best practices, and put research findings into practice. The committee’s accomplishments include a collection of federal resources on disaster behavioral health, a compendium of primary care and mental health integration initiatives across participating federal agencies, and a
research study on evidence-based programs that integrate primary care and mental health.
Meeting the needs of people with existing mental
illnesses is a challenge. Countering discrimination, undoing the
fragmentation of services for physical and mental illnesses, and managing
costs and limited resources are first steps toward a transformed mental
health system. Wisely investing in the future while making the best use of
limited resources will enable us to share the hope of recovery.
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Corresponding Author: A. Kathryn Power, MEd, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Rd, Rm 6-1057, Rockville, MD 20857.
Telephone: 240-276-1310. E-mail:
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- Mental health: a report of the Surgeon General. Rockville (MD): US Department of Health and Human Services, US Public Health Service; 1999.
- President’s New Freedom Commission on Mental Health. Achieving the promise: transforming mental health care in America. Final report. DHHS
Pub. No. SMA-03-3832. Washington (DC): US Department of Health and Human Services; 2003.
- Institute of Medicine. Improving the quality of health care for mental and substance-use conditions. Washington (DC): The National Academies Press; 2005.
Transforming mental health care in America. The federal
action agenda: first steps. Substance Abuse and Mental Health Services
Administration; 2005. http://www.samhsa.gov/Federalactionagenda/NFC_TOC.aspx.
Accessed September 4, 2009.
- Transforming mental health care in America. The federal action agenda: “a
living agenda.” Substance Abuse and Mental Health Services
Administration; 2008. http://www.samhsa.gov/Matrix/MHST/NFC_Report2008_508v.pdf.
Accessed September 4, 2009.
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