Mental Health Programs
About CMHS
Center for Mental Health Services National Advisory Council
Subcommittee on Consumer/Survivor Issues
Briefing Paper
September 5, 2002
The Center for Mental Health Services (CMHS) National Advisory Council Subcommittee on Consumer/Survivor Issues is a federally-supported body that includes people who have experienced mental illness, treatment, and recovery. The purpose of the Subcommittee is to advise the CMHS National Advisory Council of consumer/survivor perspectives on mental health issues. The Subcommittee provides experiential knowledge in seeking federal improvement of the public mental health system. The Subcommittee has provided recommendations to the CMHS National Advisory Council of the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Department of Health and Human Services (HHS) since September 2000.
The CMHS Subcommittee on Consumer/Survivor Issues supports the goals and mission of the New Freedom Commission on Mental Health to promote community integration for people with disabilities, including individuals with psychiatric disabilities. This briefing paper gives background of mental health self-care in terms of needs, models, and evidence-based practices. It recommends development of self-care programmatic approaches to assist individuals who experience mental illnesses achieve recovery.
This briefing paper includes two attachments that provide further information. Attachment 1 gives background of mental health self-care in terms of needs, models, and evidence-based practices. Attachment 2 gives public health values and principles that underlay self-care approaches to mental health.
Introduction
If any American citizens do community-level work as expressed by President Bush in his policy statement, "Rallying the Armies of Compassion," it is consumer/survivor movement participants. We who experience mental illness, treatment, and recovery are in common struggle to reclaim our humanity, our citizenry, our lives, and our roles as parents, providers, and contributing members of the larger community.
Consumers and survivors of public mental health services have earned a place at the federal policy-making table. Through our self-care approaches - self-help, self-management, and mutual/peer support activities - we engage mental health policy issues in every state and thousands of local communities. We are members of policy-making boards at the local, state, federal, and international levels.
In our use of mental health services, we are increasingly ready for a choice. It is time to reform the absolute monopoly of traditional redistributive mental health policy by use of developmental mental health policy.
Traditional mental health programs orient to lifetime dependency. They rely on diagnosis, force, medications, and maintenance. They do not focus on initiative and strength.
Traditional mental health programs integrate systems by segregating consumers into those systems.
Innovative consumer/survivor programs orient to human capacity and possibility. They focus on person, character, choice, interaction, and action. Innovative consumer/survivor programs integrate systems by integrating consumers into their families and into the larger community.
The consumer/survivor movement offers a host of developmental self-care approaches. Consumer-run self-care programs are increasingly ready to supplement or compete with a number of traditional mental health programs. We are ready for greater federal, state, and local support of our self-care approaches to mental health issues.
Recommendations
The NFCMH should: (1) support the consumer/survivor movement and its self-care approaches to mental health policy; (2) support self-care programmatic approaches that include:
Paraprofessional and Professional Workforce
The NFCMH should support the consumer/survivor movement as it develops a paraprofessional and professional workforce. That workforce should provide alternative public mental health services that supplement certain traditional public mental health services. Those innovative service providers should focus on recovery, rehabilitation, and community inclusion. Their funding should be legitimated by accreditation and certification. Vouchers should be used by consumers to choose from services offered by both innovative and traditional providers. Drop-in centers should offer a broad array of services and should serve as cost-effective outcome-driven alternatives to day treatment programs. Consumers of mental health services should less often be captive customers and more often be informed consumers who use vouchers to choose services that lead toward recovery.
Development of that workforce will also: (a) open up lines of work, career development, training, and education; (b) develop goals of the Ticket to Work/Work Incentives Improvement Act; (c) address needs for a national culturally and linguistically diverse mental health workforce; (d) provide means to deal with the limitations sustained by traditional mental health policy and programs; (e) increase capacity for ongoing minor reform and reduce need for occasional major reform in mental health policy, programs, professions, and practices.
Research
The NFCMH should support research that compares effectiveness and efficiency of innovative consumer/survivor programs and traditional mental health programs. The Commission should advocate for an end to research designed to promote a self-interested agenda, such as THE business interests of pharmaceutical companies, the job security of traditional mental health professions, and the devaluation of citizen involvement.
Continuing Education Units (CEUs)
The NFCMH should increase links between traditional providers and the consumer/survivor movement by recommending earning of CEUs by mental health professionals who attend consumer/survivor events and meetings. Traditional providers who earn those CEUs will become more informed about what self-care offers. A number of those informed providers will link their clients with self-care approaches.
The Consumer/Survivor Movement and Mental Health Professionals
The NFCMH should support links between the consumer/survivor movement and mental health professionals who have personally experienced mental illness, treatment, and recovery. Mental health professionals who have a psychiatric diagnosis ordinarily conceal that fact to avoid the accompanying loss of status. If those professionals drew social courage through common organizational support, then they would likely instill self-care concepts and approaches within their professions.
Regional and National Consumer/Survivor Coalitions
The NFCMH should support development of regional consumer/survivor coalitions that serve as regional technical assistance centers. Their boards and staff should be from existing state and local consumer/survivor leadership. Regional coalitions should form a national coalition whose culturally and ethnically diverse leadership provides a broad array of proven programmatic approaches to self-care.
Volunteer Work
The NFCMH should recommend funding of state and local volunteer programs that place consumers as volunteers in local non-profit organizations. Those programs should be run by people who have themselves experienced mental illness, treatment, and recovery. For people with a psychiatric history, volunteer work at non-profits is an excellent way to edge back into the working and social world, take on responsibility, and prepare for paid work, training, or school.
Funding
To achieve the goals and mission of the NFCMH and to reintegrate consumers
into their families and into their communities, the NFCMH should support continued federal funding for self-help initiatives such as the national consumer technical assistance centers, state networking grants, and other consumer-operated self-help programs.
The NFCMH should recommend changes in Medicaid funding that facilitate funding of consumer/provider operated programs and services. MEDICAID waivers should be used to fund those programs and services. State Medicaid staff should be given education and training that informs them how to fund those programs and services through existing Medicaid policy and procedures. Consumer leadership should participate in CMS determination of funding mechanisms for non-traditional services.
State, Local, and Private Support
The NFCMH should recommend strong federal leadership in support of self-care programs and services at the state, local, and private level. As resources shrink and systems change, state, local, and private mental health providers must meet consumer demand through technologies that are effective and efficient. Those providers seek to provide services that offer healthcare value, performance improvement, accountability, consumer independence, community integration, and recovery outcomes. Self-care is a model that addresses those goals.
Certainly, traditional mental health staff cannot provide full support for all people who have psychiatric disabilities. Follow-up, outreach, and support can best be done by individuals who have experienced psychiatric disability, treatment, and recovery. Self-care programs cost less than comparable traditional programs. Their use is accompanied by reduced use of costly traditional services. Self-care programs are cost-neutral, cost-efficient, or cost-reducing. Through federal leadership, state, local, and private mental health programs can learn how to develop innovative self-care programs and link them with traditional programs.
Discrimination and Stigma
The NFCMH should endorse the use of the phrase "discrimination and stigma" in place of the word "stigma." The phrase "discrimination and stigma" was endorsed by the CMHS National Advisory Council with the understanding that stigma is a form of discrimination and a civil rights issue.
Housing
The NFCMH should ensure that supportive housing policy and regulations include all consumers, including those with family and children. Federal funding streams should support housing services that are not bundled with the requirement that recipients of these services be in active treatment.
The National Institute of Mental Health
The NFCMH should recommend that the National Institute of Mental Health (NIMH) establish a fact finding body similar to the CMHS' National Advisory Council's Subcommittee on Consumer/Survivor Issues that creates a mechanism for consumer/survivor input on NIMH research priorities and activities.
Non-coercion
The NFCMH should recommend that non-coercion be a guiding principle of all federally funded mental health treatment.
Recovery
The NFCMH should recommend that recovery be the goal of all federally funded mental health treatment and should be measured by outcomes.
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