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White House New Freedom Mental Health Commission


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Daniel Fisher was appointed to the White House New Freedom Mental Health Commission. He saw his role as giving voice to the millions of mental health consumers, survivors, and ex-patients who are often without a voice. His term ended in April, 2003 and he now sees his role as facilitating the implementation of the commission.

Click here to download report: "Implementing the President's New Freedom Commission on Mental Health", By Daniel Fisher, MD, PhD, National Empowerment Center, Inc., Member of the Commission

UPDATE SEPTEMBER 15, 2003

The final report of the White House New Freedom Commission on Mental Health is out. You can get a copy online: www.mentalhealthcommission.gov or call SAMHSA: 800-662-4357 (TTY:800-228-0427).

UPDATE JULY 24, 2003

We got good coverage in the Boston Globe, page 3 and the NY Times. Here is an AP adaptation of story in the Globe:

Mental health care needs overhaul, says presidential panel.  Report emphasizes early screening and quality-of-life issues

By Laura Meckler, Associated Press, Globe Staff, 7/23/2003

WASHINGTON -- Treatment for millions of mentally ill Americans should go beyond medication to help people find jobs, make friends, and otherwise live meaningful lives, a presidential commission recommends in a report that calls for an overhaul of the system.

In a report released yesterday, the commission recommends that people with mental illnesses and their families have a larger say in their treatment. It says care plans should do more than just treat disease symptoms.

It also recommends early screening so children with mental disorders can be diagnosed early and get help sooner. And it says innovative treatments and ideas must get into the field as soon as they are proven effective.

''The commission recommends fundamentally transforming how mental health care is delivered in America,'' said the final report of the President's New Freedom Commission on Mental Health.

''The time has long passed for yet another piecemeal approach to mental health reform,'' said Michael F. Hogan, commission chairman and director of the Ohio Department of Mental Health.

''This report provides the president with a road map for that transformation.''

The new report builds on studies by former US surgeon general David Satcher on the nation's troubled mental health care system.

In 1999, Satcher said about half of the 50 million Americans who suffer from mental illness were not getting treatment because of the stigma and financial issues. He called for parity in insurance coverage with that for physicial ailments.

Critics say the system responds to crises. People are kept on medications that squelch symptoms.

Under a new model, counselors would develop a plan to help the patient live a fuller life -- including, but not limited to, medication.

Health and Human Services Secretary Tommy Thompson called the new report ''thorough and thoughtful,'' and directed the Substance Abuse and Mental Health Services Administration to review its recommendations. Charles Curie, who heads that agency, embraced the commission's findings.

''Most of all, the report reminds us that mental illness is a treatable illness and that recovery is possible,'' Curie said in a statement.

About 5 percent to 7 percent of adults in the United States have a serious mental illness, the commission said, and a similar proportion of American children suffer from a serious emotional disturbance.

The commission, which was created by President Bush in April 2002, recommended that each state develop a comprehensive plan for transforming its system of care for the mentally ill.

Those systems typically combine institutional and community-based care and are financed by a combination of state, federal, and private dollars.

The report does not recommend spending any additional money, but says that states should be given more flexibility in using funds available through federal programs if they develop strong plans.

In addition, the report recommends that government encourage better care by paying mental health organizations for treatments and services that are ''based on proven effectiveness and consumer preferences -- not just on tradition or outmoded regulations.''

''This report brings hope to people living with mental illness -- hope of recovery, not just symptom relief,'' said Dr. Daniel Fisher, a Wakefield psychiatrist and consumer advocate, who served on the commission.

''The significant emphasis on employment, housing, and consumer support,'' is a significant change.

''I see it as a steppingstone,'' added Fisher, co-director of the National Empowerment Center, a Lawrence-based consumer group. ''Advocates and consumer leaders have not gotten to the table in significant numbers but if you walk into a meeting and hold up this document, that can have profound effect.''

''Let today be the turning point,'' said Richard Birkel, national executive director of the National Alliance for the Mentally Ill. ''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.''

In its report, ''Achieving the Promise: Transforming Mental Health Care in America,'' the commission also recommends that:

Education be emphasized to help people understand that mental illness is not something to be embarrassed about, in hopes that people who need help will seek it.

Special educational attention be directed at rural Americans, racial and ethnic minorities, and people whose primary language is not English.

Consumer rights be recognized and respected and seclusion and restraint used only as a last resort.

Children will be routinely screened for mental disorders.

Alice Dembner of the Globe staff contributed to this report.

This story ran on page A3 of the Boston Globe on 7/23/2003. © Copyright 2003 Globe Newspaper Company.

UPDATE JULY 23, 2003

Fellow Colleagues,

The final report of the White House New Freedom Commission on Mental Health is out. You can get a copy online: www.mentalhealthcommission.gov or call SAMHSA: 800-662-4357 (TTY:800-228-0427).  Now the real work of the White House Commission begins.

I would recommend that consumer/survivor leaders take this commission as a call to action. We can assemble a National Recovery Work Group whose task could be to develop a strategy for implementing the commission recommendations.

I want to thank you all for your hard work, thoughtful comments, appearances at public meetings, testimony, but above all for your support. I felt outnumbered but never alone on the commission. Whenever other commissioners would try to cut down my contribution I would remind them that there were millions more of me outside the door. That usually made them back off. The two major issues I focused on, recovery through self-determination and empowerment and rights were well represented in the final report.

I am impressed by the many ways that recovery is referred to in the report. I can hardly believe that the vision statement reads;

" We envision a future when everyone with a mental illness will recover..."

"The Goal of a transformed system: Recovery (p. 4)" ....

Each consumer will have an Individualized plan of care in which consumers will be "choosing the health care professionals on their team...sharing in the decision making...and having the right to agree or disagree with their treatment plan."

"Because recovery will be the common, recognized outcome of mental health services, the stigma surrounding mental illness will be reduced, reinforcing the hope of recovery for every individual with mental illness...

Successfully transforming the mental health system rests on two principles:

  1. Services and treatments must be consumer and family centered, geared to give consumers real and meaningful choices
  2. Care must focus on increasing consumers' ability to successfully cope with life's challenges, on facilitating recovery, and building resilience, not just managing symptoms."

"Goal 2: Mental Health Care is Consumer and Family Driven: recommendation 2.2: Involve Consumers and families fully in orienting the mental health system fully towards recovery: Local, State, and Federal authorities must encourage consumers and families to participate in planning and evaluating treatment and support services. The direct participation of consumers and families in developing a range of community based, recovery-oriented treatment and support services is a priority. ..

Recovery-oriented services are often successfully provided by consumers through consumer-run organizations and by consumers who work as providers in a variety of settings, such as peer support, and psychosocial rehabilitation programs. (p. 37)." Under recommendation 5.3 (p. 75)  " Every mental health education and training program in the nation should voluntarily assess the degree to which it:

  • Educates consumers, families, and consumers about mental illness and ...recovery...
  • Engages consumers and families as educators of other health care providers...
  • All training curricula should clearly reflect the perspectives of consumers and families."

UPDATE APRIL 14, 2003

The White House Commission is winding down. I feel I made some small progress, at least to this point. I was able to get the idea of recovery into the Interim Report and some of the draft language. But it has been a struggle. Thank you all for your support during this trying year.

Our Last public hearing was held April 3rd. We presented an outline of our final report at that meeting. The outline consisted of a vision statement which started by saying that recovery was an expected outcome for all consumers. This was followed by 6 goals:

  1. Mental health is essential to overall health
  2. Consumer/family centered care
  3. Cultural competence/eliminate disparity
  4. Treatment interventions/screening
  5. Best care science can discover and offer
  6. Information technology

There were 21 recommendations of which the ones of particular interest to consumer/survivors would be:

  • National Campaign to reduce stigma
  • Expanding the recovery-oriented system by increasing the opportunities and capacities of consumer to share their inspiration, knowledge and skills
  • Each person will have a single recovery plan which will reflect their goals and hopes 

We are hopeful that the final report will be released in May. We have also been working on issue papers. Below or on the commission website, www.mentalhealthcommission.gov, you can find summaries of the two issue papers I worked the hardest on, consumer issues and Rights and Engagement. We will finalizing these papers (there are about 14 issues papers). They will be published separately in the near future.  

Daniel Fisher

NEWS UPDATES:

White House Commission:

Background papers for the commission: