Schizophrenia.com - New Freedom Commssion Report on Mental Health

Index of Report Contents:

Introduction
The New Freedom Commssion Report on Mental Health: Summary of Key Points
Details on Each of the Six Main Goals (including Commission summary and editorial commentary):

Americans Understand that Mental Health is Essential to Overall Health

Mental Health Care is Consumer and Family Driven

Disparities in Mental Health Services are Eliminated

Early Mental Health Screening, Assessment, and Referral Services are Common Practice

Excellent Mental Health Care is Delivered and Research is Accelerated

Technology is Used to Access Mental Health Care and Information

Responses of Official Medical, Legal, and Advocacy Groups to the Commission Report
Responses of the General Public to the Commission Report

Results of the Report - examples of recent legislation

Looking to the Future: The Presidential Candidates' Stances on Mental Health Care

President George W. Bush
Senator John Kerry

Closing Thoughts
Endnotes

Introduction to the President's New Freedom Commission:

In April of 2002, President George W. Bush created the New Freedom Commission on Mental Health, a 22-member committee that included MDs and PhDs, social services and community health representatives, policy makers, and judicial officials. Their mission: "to study the mental health service delivery system, and to make recommendations that would enable adults with serious mental illnesses and children with serious emotional disturbance to live, work, learn, and participate fully in their communities."[1]. To accomplish this task, the committee reviewed a comprehensive list of background materials (http://www.mentalhealthcommission.gov/bibliography.htm), and solicited public comments and recommendations from consumers, parents, family members, advocates, service providers, educators, researchers, and other concerned individuals. On July 22, 2003, the Committee issued their final report on the state of mental health care in America.

The New Freedom Commission Report: A Summary of Key Points

Overall Recommendation: "A fundamental transformation of the Nation's approach to mental health care…ensur[ing] that mental health services and supports actively facilitate recovery, and build resilience to face life's challenges"[2].

Unmet needs and barriers to care, as identified by the Commission:[3]

Fragmentation and gaps in care for children and adults with serious mental illness

High unemployment and disability for people with serious mental illness

Lack of care for older adults for mental illness

Lack of national priority for mental health and suicide prevention

(Additionally, President Bush identified the following three elements as key barriers to quality mental health care in America):

Stigma that surrounds mental illnesses

Unfair treatment limitations and financial requirements placed on mental health benefits in private health insurance

The fragmented mental health service delivery system

The Goal of a Transformed System is Recovery. In the report, recovery is defined as "the process in which people are able to live, work, learn, and participate fully in their communities. For some, recovery is the ability to live a fulfilling and productive life despite a disability. For others, recovery implies the reduction or complete remission of symptoms.[4]

Specific Goals of a Recovery-based Mental Health Care System:[5]

1. Americans understand that mental health is essential to overall health

2. Mental health care is consumer and family driven

3. Disparities in mental health services are eliminated

4. Early mental health screening, assessment, and referral to services are common practice

5. Excellent mental health care is delivered and research is accelerated

6. Technology is used to access mental health care and information

Details on each of the six identified goals, as defined in the report, as well as editorial/third party commentary:

Goal 1: Americans Understand that Mental Health is Essential to Overall Health

In the Words of the Commission:

With this goal, the commission hopes to destigmatize mental health care, so that "Americans will seek mental health care when they need it - with the same confidence that they seek treatment for other health problems." They propose to achieve this through "learning, self monitoring, and accountability."

Specific Recommendations of the Commission to Achieve This Goal:

1. Education campaigns that emphasize facts about mental illness and reduce stigma, that target specific audiences such as rural Americans, racial/ethnic minorities, and those whose primary language is not English.

2. Allow more mental health diagnosis and care to take place in primary care settings, by providing the necessary time, training, and resources to primary care physicians.

3. Advance a national campaign to reduce stigma, and a national strategy for suicide prevention.

Editorial Comments on Goal 1:

The above recommendations, though excellent for increasing access and awareness, make the false assumption that all mental health care consumers are fully aware of their own illness. The report states: "in a transformed mental health system, Americans will seek mental health care when they need it"[6]. Unfortunately, the commission fails to acknowledge the fact that a hallmark of serious mental illness is lack of insight. This portion of the patient population will not seek treatment on their own behalf, no matter if access is improved and stigma reduced.

Goal 2: Mental Health Care is Consumer and Family Driven

In the Words of the Commission:

The purpose of this goal is to provide a "well-planned, coordinated…personalized, highly individualized health management program [that] will help lead the way to appropriate treatment and supports that are oriented toward recovery and resilience"[7]. The commission asserts that a consumer-centered, recovery-oriented mental health care plan will "include treatment, supports, and other assistance to enable consumers to better integrate into their communities; it will allow consumers to realize improved mental health and quality of life."

Specific Recommendations of the Commission to Achieve This Goal:

1. Consumers and families, in partnership with their health care providers, will play a larger role in managing funding, treatment, and supports.

2. The burden of coordinating care will rest on the system, not on the family or the consumer.

3. States will develop comprehensive mental health plans to outline responsibility for coordinating and integrating programs at the federal, state, and local level. States will be allowed to combine federal, state and local resources to fund their innovations.

4. Services will be delivered in the most integrated setting possible - in communities rather than institutions.

5. Issues of child custody will be separated from issues of care.

6. Mental health consumer rights will be protected and enhanced, particularly in areas of employment, secure health care, and safe housing.

Editorial Commentary on Goal 2:

Promoting consumer and family participation in developing treatment plans is a progressive step. The experiences of each person and family touched by mental illness are highly individualized, and attempting to provide overly-standardized treatment plans leave many people with inadequate treatments for their unique situations. Developing comprehensive state plans for mental health may help to coordinate a fragmented system of care, combining social services for housing, vocation, and community rehabilitation with long-term medical treatment plans. Offering more community-based services will hopefully improve access for the majority of consumers. The protection of rights should be practically a given, and the promotion of legislation such as the American Disabilities Act helps to achieve this. A good addition to this point might be an emphasis on informing people of their rights as mental health care consumers. For example, many don't realize that it is not required to reveal a mental illness to an employer (there are a very few exceptions to this rule, such as jobs in the military or in ordained ministry). Consumers cannot assert and protect rights that they don't know about.

The report speaks of "protecting and enhancing mental health care consumer rights, particularly in areas of employment, secure health care, and safe housing." Inherent in this, but not explicitly addressed, is the need to reform federal insurance and aid programs (such as SSI and SSDI) to continue adequate and vital financial support for mental health consumers and their spouses or legal guardians as they seek to return to work. Many families are caught between the need to add extra income, and the fear of losing their federal benefits. According to NIMH statistics, this country loses $105 billion annually due to lost productivity. That is over 1/2 of the entire annual estimated costs of mental illness in the United States. The federal and state governments can help replace this lost productivity by reforming programs to support workers returning from disability, rather than crippling them.

The details of Goal 2 again ignore the key issue of consumer insight. The report states: "[b]y allowing funding to follow consumers, incentives will shift toward a system of learning, self-monitoring, and accountability. This program design will give people a vested economic interest in using resources wisely to obtain and sustain recovery" [8]. This statement makes the broad assumption that consumers misuse, or neglect to use, available services because they are not properly motivated. In reality, a large number of mentally ill consumers don't utilize available services because they don't realize that they are sick. No one will be self-motivated to use treatments and resources that they don't believe they need.

Moreover, this author would like to see within this goal a larger emphasis on reducing stigma, which is a key element for community integration. Mental health consumers must feel comfortable and justified in seeking treatments and programs, and the rest of the community must be willing to support and accept them when they do. This will only happen when stigma breaks down on both sides.

Goal 3: Disparities in Mental Health Services are Eliminated

In the Words of the Commission:

This goal seeks to allow everyone to "share equally in the best available services and outcomes, regardless of race, gender, ethnicity or geographic location"[9]. It emphasizes reaching culturally diverse and minority populations (i.e. rural communities, linguistic/ethnic minorities, gender groups, etc) with health care services that are tailored to their specific needs.

Specific Recommendations of the Commission to Achieve This Goal:

1. Providers of services will include individuals who share and respect the beliefs, norms, values, and patterns of communication of culturally divers populations.

2. Utilizing tools such as videoconferencing and tele-health (care provided by telephone) to improve access to care and advance treatment in rural and remote areas.

3. Provide mental health education and training to public servants that regularly interact with mentally ill individuals - specifically, emergency room staff, first responders, law enforcement personnel, and EMTs.

Editorial Commentary on Goal 3:

Minority groups - particularly non-English speakers - are often overlooked in mental health care services and legislation. It is encouraging to see a goal specifically addressing the needs of these populations. Tools such as therapy by phone have already shown early success (see "Therapy via Telephone Shows Promise" - schizophrenia.com newsblog, Sept 1 2004) - these may indeed help to improve access to care in hard-to-reach areas. And any family that has had run-ins with police (an unfortunately common occurrence for those suffering from untreated mental illness) knows the importance of having an informed and sensitive law enforcement staff (see "The Crisis Cops", a schizophrenia.com news report from February 2004 that advocates such training for police forces).

Given that the stated goal is "eliminating disparities in mental health services," it is unfortunate that the Commission does not address one of the largest barriers - that is, lack of adequate insurance. According to statistics from the Treatment Advocacy Center, about 1/3 of America's homeless population (totaling close to 600,000) suffers from a serious mental illness such as schizophrenia or bipolar disorder. According to the TAC, there are more people living on America's streets with untreated or undiagnosed mental illness than are currently receiving care in hospitals. These people are largely uninsured, which prevents access to needed diagnostic services, therapy, and costly medications. Even those that are insured under publicly funded programs (Medicare or Medicaid) may have insurmountable co-payments and prescription drug costs for their mental illness treatments. To eliminate this barrier, the government must make insuring every American a top priority, and also must reform public insurance programs to provide the same coverage benefits for mental conditions as for physical conditions. Passage of The Paul Wellstone Mental Health Equitable Treatment Act (2003), currently stalled in Congress, would do much to achieve this end.

Goal 4: Early Mental Health Screening, Assessment, and Referral Services are Common Practice

In the Words of the Commission:

With this goal, the commission advocates making mental illness screening a more routine occurrence for both children and adults. This would hopefully lead to earlier detection, and thus earlier treatment intervention. Early diagnosis and intervention has been shown to improve prognosis and potential for recovery for those with mental illness.

Specific Recommendations of the Commission to Achieve This Goal:

1. Provide mental illness screening for children and adults during routine physical exams.

2. Provide screening and early intervention services in accessible and/or high-risk settings such as primary health care facilities, schools, criminal justice and child welfare systems.

3. Co-screen for mental and substance abuse disorders, and provide integrated treatment strategies for dual-diagnosis patients.

Editorial Commentary on Goal 4:

It is already well documented that early diagnosis and intervention can greatly improve the quality of life of a mentally ill individual, as well as increase the potential for recovery (see "Earlier Diagnosis of Schizophrenia Improves Results of Treatment", schizophrenia.com Newsblog, Feb 26 2004; see also The Importance of Early Intervention and Treatment for Schizophrenia on the schizophrenia.com website, which contains numerous research articles and references). Providing integrated treatment for dually-diagnosed patients would also be a welcome addition to mental health care services, as there is a current lack of good programs that address both problems simultaneously.

Some parties have expressed concern over the Commission's recommendation to initiate mental health screening in America's schools. Says Karen R. Effrem, M.D. and a director of EdWatch: "I am concerned, especially in the schools, that mental health could be used as a wedge for diagnosis based on attitudes, values, beliefs, and political stances - things like perceived homophobia" (Source: WorldNetDaily, "Forced mental screening hits roadblock in House", Sept 9 2004). Other critics (quoted from the same source) "say [the initiative] is a thinly veiled attempt by drug companies to provide a wider market for high priced anti-depressants and anti-psychotic medications, and puts government in areas of Americans' lives where it does not belong."

The Commission justifies its recommendations by asserting that "despite their prevalence, mental disorders often go undiagnosed," and concluding that schools are in "a key position" to screen 52 million students and 6 million adults employed by schools.

Illinois was the first state to approve a statewide mental health-screening program based on the New Freedom Commission recommendations (The Children's Mental Health Act of 2003), which provides screening for all children under the age of 18. The Commission held up the Texas screening program TMAP (Texas Medication Algorithm Project) as a "model" medication treatment plan. TMAP has previously raised concerns about alternate motives, such as over-promoting certain pharmaceuticals (see schizophrenia.com newsblog entry from June 22, 2004 for more information on TMAP and mandatory screening controversy). We will have to look to the future to guage the success of the Illinois initiative.

Goal 5: Excellent Mental Health Care is Delivered and Research is Accelerated

In the Words of the Commission:

This goal promotes the future use of evidence-based medications and therapies. Evidence-based is not specifically defined by the commission; however, in a recent article released by the 2004 Council of State Governments (Sept 1, 2004), evidence-based practices for mental health care is defined as "interventions with clear scientific evidence demonstrating improved client outcomes. The article provides several examples of evidence-based practices already in use - Assertive Community Treatment, supported employment, self-management education, and family psycho-education are a few examples.

Furthermore, the commission advocates the expansion of research to develop and refine more evidence-based treatments and services, the most effective of which will become immediately available. "Research discoveries will become routinely available at the community level…the Nation will continue to invest in research at all levels"[10].

Specific Recommendations of the Commission to Achieve This Goal:

1. Accelerate research to promote recovery and resilience, and ultimately to cure and prevent mental illness.

2. Advance evidence-based practices in the community, via public-private partnerships.

3. Improve and expand the workforce with evidence-based practices.

4. Improve research and understanding in four key areas: mental health disparities, long-term effects of medication, trauma, and acute care.

Editorial Commentary on Goal 5:

A commitment to implementing evidence-based practices in the community - programs such as Assertive Community Treatment and supported employment have already proven successful in many contexts - is an excellent step. Funding and accelerating research to refine and develop new evidence-based practices is also a welcome addition.

We hope that the commission considers Assisted Outpatient Treatment as an evidence-based practice. Statistics show that Assisted Treatment reduces hospitalization, reduces violent crimes and arrests, increases treatment compliance, and improves symptoms in people with severe mental illnesses and poor insight. See the data about the results of assisted outpatient treatment at the Treatment Advocac Center website (http://www.psychlaws.org).

It is important for the medical and scientific community to pay attention to what areas of research are being funded, and consider whether they are areas of greatest need. Dr. E Fuller Torrey, a PHD and leading advocate for the mentally ill, has previously criticized federal research institutions such as the NIMH for neglecting research projects on serious mental illness in favor of easier, more gratifying pursuits (read Dr. Torrey's report - A Federal Failure, available at http://www.psychlaws.org). Moreover, the federal government has blocked public funding for embryonic stem cell research, on the grounds that it is unethical and unnecessary to destroy even frozen embryos when stem cell lines are already available. However, scientists have identified the majority of these lines as being contaminated, or in other ways unsuitable to carry out good research. The government and the scientific community need to seriously weigh the real possibilities of developing life-saving and life-altering therapies for condtions such as Alzheimer's, Parkinson's, and spinal trauma against the value of preserving frozen, unused fetus embryos. (For more information about stem cell research and its potential, see this NIH Stem Cell Basics Report. For information on how stem cell research might eventually benefit people with psychiatric diseases such as schizophrenia, see the Schizophrenia.Com Newsblog entry on Oct 19, 2004 - "Stem Cell Research Update").

Just recently, the medical community has taken steps to eliminate research bias in clinical drug trials. Responding to pressure from leading medical journals, officials, and the consumer community, some private pharmaceutical companies now publish all study results (not just positive or conclusive ones) on a public registry. Although companies can choose not to participate in full disclosure, some journals will not accept studies from these institutions (read the schizophrenia.com newsblog report from Sept. 8 for the original source article). There are also bills currently on Capitol Hill that, if passed, would make full disclosure a requirement of all institutions [11]. This may help to encourage need-driven, rather than market-driven, research, as well as provide health care providers and consumers all the information they need to make informed decisions about their own cases.

Goal 6: Technology is Used to Access Mental Health Care and Information

In the Words of the Commission:

This goal emphasizes streamlining the delivery of excellent health care services. In the words of the commission: "…advanced communication and information technology will empower consumers and families and will be a tool for providers to deliver the best care"[12]. Making this technology an integrated and routine part of mental health care will hopefully improve access in underserved, rural, and remote areas. The commission also hopes to strongly protect and ensure patient privacy with protected electronic records.

Specific Recommendations of the Commission to Achieve This Goal:

1. Use health technology and tele-health to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations.

2. Develop and implement integrated electronic health records and personal health information systems, which might be used for self-management of care, clinical appointments and reminders, prescription guidelines, patient medical histories and drug allergies, etc.

Editorial Commentary on Goal 6:

Bringing health care delivery into the 21st century with improved technology and electronic records has great potential to improve continuity of care. In an increasingly mobile society, electronic records that are shared across a protected medical network will provide faster, more accurate information for any new doctor in any new location. That provider can then hopefully continue the present treatment without interruption or backtracking.

Responses of Official Medical, Legal, and Advocacy Groups to the Commission Report

The New Freedom Commission Report has the potential to affect changes not just the public sector, but in private plans and community programs as well. The response from various medical and legislative groups has been largely positive - organizations voicing support include the Campaign for Mental Health Reform, the National Alliance for the Mentally Ill (NAMI), the National Association of State Mental Health Program Directors, the National Mental Health Association, and the American Psychiatric Association (APA). These and other groups called on the president and Congress to act on the recommendations made in the report.

However, others have voiced concerns that this comprehensive report failed to address some key areas of mental health.

In an editorial critique of the report ("Commission's Omission - The president's mental health commission in denial"), the Treatment Advocacy Center (TAC) identified several issues that were not addressed:

Legislation or support programs for people with poor insight. According to TAC statistics, 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder lack adequate awareness of their own illness. This is a biological consequence of mental illness, caused largely by damage to certain areas of the brain. Lack of insight is the most often-cited reason for why some people with brain diseases do not stay on medication or in treatment programs. The commission recommendations for family- and consumer-driven mental health care assume that all consumers are fully aware of their disease, and thus motivated to adhere to treatment options.

The criminalization of the mentally ill. The TAC proposes that a reduction in stigma through education campaigns is the wrong focus. Instead, they recommend developing more specific treatments and long-term treatment plans, to reduce the violent/erratic behavior of the untreated mentally ill. Such violent behavior in this population is dramatically associated with untreated illness (see Treatment Advocacy Center website for information and statistics on this subject).

Endorsement of certain evidence-based practices, such as mental health courts (for trying mentally ill offenders) and assisted outpatient treatment. Both of these programs have shown great promise in improving the lives and enhancing community integration of people with brain disease.

The fact that a national plan based on a "recovery model" (as defined by the New Freedom Commission report) is still unrealistic for many who suffer from brain disease. If recovery is to be defined as "the process in which people are able to live, work, learn, and participate fully in their communities," then those who are most severely disabled will be left out of future policy and support programs.

Insurance parity for mental health care in the public sector. For example, Medicare currently has a 50% consumer co-pay for mental health services, as opposed to a 20% co-pay for other health services. The Paul Wellstone Mental Health Equitable Treatment Act (2003) currently outlines the most progressive plan for parity.

Psychiatric Times also published an editorial critique of the Commission report ("The New Freedom Commission's Report to Shape Mental Health Policy in Years Ahead" - Oct 2003). Although the tone was largely positive, Psychiatric Times brought up two major points of contention: the question of resources, and the omission of involuntary treatment programs. As psychiatrist and APA vice-president Steven S. Sharfstein pointed out in the article, "To argue that there are enough resources in the system, which is implicit in the report, and not to say that we need more resources, is wrong." Relevant points missing from the Commission's report include recommendations concerning the amount of private insurance premium devoted to mental health care, and mental health equity under public programs such as Medicaid.

Sharfield also maintained: "the report does not do justice to individuals in the most dire straits in society. It emphasized choice, but there are a large number of individuals who aren't able to choose." This includes not only those with poor insight, but also the innumerable number of mentally ill people who are homeless or in prison. He believes that involuntary treatment (which he prefers to call 'compassionate coercion') is sometimes necessary to avoid crisis situations later on, and that this was not adequately addressed by the report.

Responses of the General Public to the Commission Report

In compiling its report, the New Freedom Commission solicited public comment from over 1200 individuals, including mental health consumers, family members, advocates, service providers, educators, researchers, and others[13]. They identified various themes that continue to be barriers to an adequate and excellent system of care, including:

Inadequate funding for services and supports

Gaps in service and provider availability

Absence of culturally competent services

Lack of systemic orientation to recovery

Inability to obtain insurance

Lack of mental health insurance parity

Low benefit limits

Excessive management of mental health benefits

Poor coordination of services and among providers

Difficulty enrolling in care programs

High service costs

Challenges of living in the community with a mental illness (stigma, unemployment, lack of housing, inadequate income support, frequent involvement with criminal justice system.

Although the Commission did an admirable job researching many of these issues, and developing specific recommendations for their improvement in the near future, there are areas that were clearly not addressed. Questions of service funding, low benefit limits, and concerns about the affordability and parity of health insurance, are just a few of the items above that the report does not fully deal with.

Results of the Report - examples of recent legislation affecting (for better or worse) mental health care services and consumers:

(Specific congressional bills mentioned below are available online at http://www.thomas.loc.gov/)

At the Federal Level:

1. New funds approved for mental health programs - State Incentive Grants to encourage comprehensive state mental health planning, 2.2% increase in Health and Human Services Department funds, 3.1% increase to SAMSHA funds, 2.7% increase for NIH funds. (Source: "House Takes First Step in Setting Funding Levels for Key Mental Health and Substance Abuse Programs", NMHA Legislative Alert, July 9 2004).

2. Mandatory mental health screening for every American child - currently in the House of Representatives. (Source: "Forced mental screening hits roadblock in House", WorldNetDaily, Sept 9 2004).

3. TeenScreen - a program to screen for mental illness among adolescent populations (currently active in 36 states). Held up as a model program in the New Freedom Commission report. (Source: "Experts at Columbia University Advise Parents to Add Mental Health Check-UP to Teens' Back to School List", U.S. Newswire release, Aug 26 2004).

4. Passage of the Garret Lee Smith Memorial Act, which devotes $82 million to identifying and treating at-risk youth. (Source: "Congress gives OK to Smith suicide bill", Oregonlive.com, Sept 10 2004).

5. House and Senate approval of the "Mentally Ill Offender Treatment and Crime Reduction Act of 2004" (S. 1194), which provides $50,000 million for state and local grants intended to positively reform how the legislative system deals with non-violent mentally ill or substance-abusing offenders. These reforms may include: jail diversion programs, treatment programs for incarcerated offenders with mental illnesses, community reentry programs, and cross-training of mental health, law enforcement and corrections. President Bush is expected to sign the bill into law in the near future. (Source: NAMI Mental Health Legislation Update).

6. Reauthorization of the Individuals with Disablities Act, supporting state-implemented services to preschool and school-age children. (Source: "IDEA Reauthorization", NMHA Legislative Alert, May 28 2004).

6. New Medicare drug benefit laws, to be enacted in 2006, which will potentially limit the number of approved psychiatric medications available to consumers. (Source: "Medicare Drug Program Could Limit Consumers to Old Meds", NMHA Legislative Alert, Sept 9 2004).

At the State Level:

1. Illinois: Children's Mental Health Act (2003) - statewide screening of school-aged children (Source: Illinois Leader news article, Aug 25 2004).

2. New Mexico: allows psychologists to prescribe medication, under the supervision of a physician. Meant to increase service delivery to rural areas. (Source: "New Mexico Allows Psychologists to Prescribe", viewable online at http://mentalhealth.about.com/library/weekly/aa031202a.htm).

3. Nevada: Nevada Mental Health Plan Implementation Commission (2003), created to develop a statewide action plan to initiate New Freedom Commission recommendations. (Source: "On the road to recovery: states are transforming mental health care", Council of State Governments State News, Sept 1 2004).

4. New Hampshire: Health and Human Services Commissioner John Stephen cuts funding for the state chapter of NAMI; endorses a "preferred drug" system for those in the state mental health system, which limits recipients to the more inexpensive medication options. (Source: "Benson administration contemptuously attacks mentally ill", The Union Leader and New Hampshire Sunday News, Sept 7 2004).

Looking to the Future: The Presidential Candidates' Stances on Mental Health Care:

With Election Day creeping closer all the time, both President Bush and Senator Kerry have outlined their platforms on various aspects of domestic policy. See where the candidates stand on the subject of health care and mental health services:

The President - George W. Bush:

As the man behind the New Freedom Commission, it is reasonable to assume that Bush would endorse the recommendations made by his own committee. Here are his positions on some aspects addressed by the report:

Current/Recent Policies:

A supporter of mental health care parity, Bush reauthorized the 1996 Mental Health Parity Act (originally signed by Clinton) that prevents insurance companies from creating dollar limits for annual and lifetime treatments for mental illness. Bush supports full parity, but the Paul Wellstone Act of 2003 has yet to clear Congress.
· In concordance with promises made in 2000, Bush has doubled research and clinical care funding for the NIH. He is currently seeking much lower annual budget increases.

Provided support for breast cancer research, and faith-based and community service programs (Broder, Washington Post, 9/1).

"Privacy is a fundamental right, and every American should have absolute control over their personal information, particularly their highly sensitive medical, genetic, and financial information." (Bush campaign quote in Psychiatric News, 2000). However, the administration has since eliminated a key patient-consent requirement in federal privacy regulations. Health care plans, professionals, insurers, clearinghouses, and hospitals can legally release patient information for "routine transactions" if they have made a "good faith effort" to notify the patients involved. However, it is not required to obtain official consent.

Bush has yet to make good on his promise to support patients' rights to sue HMO or managed care organizations. (According to Psychiatric News - June 15, 2001).

Future Plans/Promises:

Cover an additional 2.4 million uninsured Americans with health insurance, using refundable tax credits. For expenses not covered by plans, Bush endorses tax-free health savings accounts, made possible with federal assistance.

Institute medical liability reform to help control soaring health care costs and malpractice insurance.

Make sure that "every poor county in America has a community or rural health center" and to lead an "aggressive effort to enroll millions of poor children who are eligible but not signed up" in SCHIP. " (Source: Bush speech text, New York Times, 9/3)

Significant investments in health care information technology; plans to implement electronic medical records for the majority of Americans.

The Challenger - Senator John Kerry:

Current Policies and Future Plans:

Like Bush, Kerry endorses full parity for mental health care. He is a supporter of the Paul Wellstone Act (2003).

Kerry vows to reform Medicare for those with mental illness; he is a co-sponsor of the 2001 Medicare Mental Illness Nondiscrimination Act. He also promises to protect Medicaid, and pushes for expanding the program to allow coverage of children with disabilities in low-income families.

Proposes health coverage for 27 million uninsured residents, funded by repealing some of the Bush administration tax cuts. Promises 75% federal coverage of catastrophic health-related costs to employers that offer health insurance to all employees, provide disease management for employees with chronic conditions and pass savings from health insurance costs on to workers. He claims that this catastrophic coverage will lower consumer health care premiums by as much as 10%.

Plans to allow the secretary of Health and Human services to negotiate lower drug prices with pharmaceutical companies for Medicare beneficiaries. He would also permit Americans to purchase FDA-approved imported prescription drugs from Canada.

Kerry is a supporter of the Family Opportunity Act (struck down in the House of Representatives), which helps protect Medicaid coverage for parents looking to return to work.

Seeks to remove federal funding restrictions to stem cell research, a promising source for new therapies.

Promises to pass a "patient bill of rights", allowing citizens to sue HMOs for harmful decisions.

He pledges support for funding and expanding community-based treatment programs and services, making mental health a priority in homeland security, reducing stigma, and instituting court reforms. No specific details were offered concerning these statements.

Sources for the above, and statements for each candidate, can be found in the following documents:
· Kerry's Statement on Mental Health Policy - http://www.johnkerry.com/pdf/mental_health_statement.pdf
· Bush's Statement on Health Care - http://www.georgewbush.com/HealthCare/
· Kerry's Health Care Reform Plan - http://www.johnkerry.com/issues/health_care/
· Key Components of the President's Health Care Reform Agenda - http://www.whitehouse.gov/news/releases/2002/03/20020301-1.html

Closing Thoughts:

Thank you for taking the time to read and consider the information in this report. We hope you have found it informative and helpful, and that you will continue to be proactive about the rights that you deserve in health care. Make your voice heard - don't forget to vote on Nov. 2!

Endnotes:

1. New Freedom Commission on Mental Health, Executive Summary of Final Report. Cover page. Available in html format at http://www.mentalhealthcommission.gov/reports/FinalReport/toc.html
2. New Freedom Commission on Mental Health (NFC on MH), Exec Summary. Cover page.
3. NFC on MH, Exec Summary, pp 4-5.
4. NFC on MH, Exec Summary, p. 7
5. NFC on MH, Exec summary, p. 8
6. NFC on MH, Exec Summary, p. 10
7. NFC on MH, Exec Summary, p. 12
8. NFC on MH, Exec summary, p. 12
9. NFC on MH, Exec Summary, p. 15
10. NFC on MH, Exec Summary, p. 19
11. For more information on the proposed bill, see "Joint Statement on Legislation to Introduce a Clinical Trials Registry" by Rep. Edward J. Markey and Rep. Henry A. Waxman.
12. NFC on MH, Exec Summary, p. 21
13. "A Report on the Public Comments Submitted to the President's New Freedom Commission on Mental Health." January 7, 2003. Available in pdf format at http://www.mentalhealthcomission.gov/