Here's the link to the final report from the committee that was formed to plan this program, The New Freedom Initiative (yackk!):
http://www.mentalhealthcommission.gov/reports/FinalReport/toc.html It seems that the goal is for each state to develop its own program, meeting the Federal requirements:
Quote:
To accomplish this change, the Federal government must reassess pertinent financing and eligibility policies and align reporting requirements to avoid duplication, promote consistency, and seek accountability from the States.
The underlying premise of the Commission's support for Comprehensive State Mental Health Plans is consistent with the principles of Federalism - providing incentives to States by granting increased flexibility in exchange for greater accountability and improved outcomes. ...
The intended outcome of Comprehensive State Mental Health Plans is to encourage States and localities to develop a comprehensive strategy to respond to the needs and preferences of consumers or families.
The Commission recommends that each State, Territory, and the District of Columbia develop a Comprehensive State Mental Health Plan. The plans will have a powerful impact on overcoming the problems of fragmentation in the system and will provide important opportunities for States to leverage resources across multiple agencies that administer both State and Federal dollars. The Office of the Governor should coordinate each plan. The planning process should support a dialogue among all stakeholders and reach beyond the traditional State mental health agency to address the full range of treatment and support service programs that consumers and families need. The final result should be an extensive and coordinated State system of services and supports that work to foster consumer independence and their ability to live, work, learn, and participate fully in their communities.
Here's an example of a "model program" from the report (from Texas):
Quote:
Figure 3.1. Model Program: A Culturally Competent School-Based Mental Health Program
Program
Dallas School-based Youth and Family Centers
Goal
To establish the first comprehensive, culturally competent, school-based program in mental health care in the 12th largest school system in the Nation. The program overcomes stigma and inadequate access to care for underserved minority populations.
Features
Annually serves the physical and mental health care needs of 3,000 low-income children and their families. The mental health component features partnerships with parents and families, treatment (typically 6 sessions), and follow-up with teachers. The well-qualified staff, who reflect the racial and ethnic composition of the population they serve (more than 70% Latino and African American), train school nurses, counselors, and principals to identify problems and create solutions tailored to meet each child's needs.
Outcomes
Improvements in attendance, discipline referrals, and teacher evaluation of child performance. 114 Preliminary findings reveal improvement in children's standardized test scores in relation to national and local norms.
Biggest challenge
To sustain financial and organizational support of collaborative partners despite resistance to change or jurisdictional barriers. Program's $3.5 million funding comes from the school district and an additional $1.5 million from Parkland Hospital.
How other
organizations
can adopt
Recognize the importance of mental health for the school success of all children, regardless of race or ethnicity. Rethink how school systems can more efficiently partner with and use State and Federal funds to deliver culturally competent school-based mental health services.
Sites
Dallas and Fort Worth, Texas
And here's another "model program" highlighted in the report, the TMAP (noted in a previous post above):
Quote:
The Texas Medication Algorithm Project illustrates an evidence-based practice that results in better consumer outcomes, including reduced symptoms, fewer and less severe side effects, and improved functioning.166-168 (See Figure 5.1.) However, too few consumers benefit from this practice because it is not widely used.
Figure 5-1. Model Program: Quality Medications Care for Serious Mental Illnesses
Program
Texas Medication Algorithm Project (TMAP)
Goal
To ensure quality care for people with serious mental illnesses by developing, applying, and evaluating medication algorithms. An algorithm is a step-by-step procedure in the form of a flow chart to help clinicians deliver quality care through the best choice of medications and brief assessment of their effectiveness. The target population is people with serious mental illnesses served by public programs.
Features
Development of algorithms as well as development of consumer education materials and other tools for treating serious mental illnesses. Public sector-university collaboration with support of stakeholders, education and technical assistance, and administrative supports to serve the most medically complex patients. Early phases of the project developed the algorithms and tested the benefits of their use; the program's latest phases focus on implementing TMAP in mental health treatment settings throughout the State.
Outcomes
The algorithm package implemented by Texas was more effective than treatment-as-usual for depression, bipolar disorder and schizophrenia. It reduced symptoms, side effects and improved functioning.166-168 The package's benefit for reducing incarceration is being studied. In addition, medication algorithms have been developed for treating children with depression or attention deficit hyperactivity disorder (AD/HD). TMAP algorithms have also been adapted to treat adult consumers who have co-occurring mental and substance use disorders.
Biggest Challenge
To ensure that the entire algorithm package - patient education, frequent medical visits, medication availability, and consultation - is properly implemented in other States and localities.
How other organizations can adopt
Conduct an active planning process, including meetings with stakeholders, to examine what organizational changes are needed to make the algorithm work best.
Sites
Texas; Nevada; Ohio; Pennsylvania; South Carolina; New Mexico; Atlanta and Athens, GA; Louisville, Kentucky; Washington, D.C.; San Diego County, CA; and private sector in Denver, Colorado
And, here's a link to a good discussion on the issue of mental health assessment as per the The New Freedom Initiative, which points out the areas of concern for assessing children through school systems, and discusses the fact that the real contention will be how states implement this program (Illinois and Oregon are discussed), among other issues:
http://reliableanswers.com/med/nheld_mental.asp excerpts:
Quote:
If this sounds a bit Orwellian to you, consider that you are not alone in your thinking and many people are already protesting this vehemently, and there are lots of articles being written on this subject. NHELD firmly believes that we cannot let mandatory mental health testing happen in any state and we must hope that the people of Illinois can repeal what already has been done there. We need to rally to prevent similar legislation in any state as well as federally. It's not going to be an easy task, but it is a very necessary one. This will affect everyone, including homeschoolers.
Quote:
"Benevolent programs, done with the best of intentions, are the road to tyranny."
Of course the issue at hand is all about the screening, labeling and drugging of all 270+ million Americans. Aldous Huxley, author of Brave New World was apparently not writing complete fiction.
I might add, having worked as a state vocational rehabilitation counselor for adults for many years, with a full caseload of persons with severe mental health conditions, that much of this report, in all honesty
seems well-intentioned.
A huge complaint we have in Vocational Rehab is the difficulty in bridging services, and this report addresses the need for continuity of services. Also, the discussion about "supported employment" for mental health clients is right on---it's a service that is sorely needed for Seriously Mentally Ill clients who desire to work, but it's a service that VR is not able to provide under current VR statutes (the report makes it seem like VR won't provide it--- actually, Federal funding to state VR programs depends on meeting goals of a set number of "successful closures", meaning the client is working, and a successfully closed case can not occur if supported employment services are occuring--it's a catch 22--anyway, that's off topic).
It does concern me in having read the report that there is a big (and suspicious) emphasis on medications and the need for medication studies, especially for children. On the otherhand, while working on location at my state mental health institute, I know that one of the biggest complaints that case managers have is lack of funding for consistent and newer meds for the clients.
Anyway, it troubles me that the drug companies may have ulterior motives here, and what appears a benign and well-intentioned effort to help persons with mental illness has such potential for corrupt or inept practices and results.
Some of my concerns are any notion of mandatory mental health screening of children in schools (especially without parental consent), any mandated medication treatment for children (especially if it is mandated that the meds be taken in order to participate in a program--this is actually similar to what our state VR program requires in order for the client to receive continued employment services--although the specific medication is per the MD), the potential for unqualified persons performing assessments, mismanaged medication treatment (psychotropic meds are unpredictable, have tremendous side effects, and the MD's don't really spend enough time to assess patients/clients adequately--their caseloads are huge!), and misdiagnosis (for example, ADHD/ADD in children is often misdiagnosed and medications can be disastrous), to name just a few.
Overall, given the history of this current (mis)administration, its connection and allegiances to corporations rather than to the people, and the fact that I just don't ever trust our government very much (but especially with Bush & Co. leading it), I suspect this big government program has potential for far too much abuse of power: the room for malicious manipulation and error is great. Giving this amount of power to big drug companies and crooked administrations should raise a red flag.
edited for spelling
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