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National Advisory Council Subcommittee on Consumer/Survivor Issues

Washington, DC
June 23-24, 2003

Welcome and Introductions
Acting chair Kevin Fitts called the subcommittee meeting to order on June 23, 2003, at 10:00 am. Other subcommittee members present included Jon Brock, Juli Anne Lawrence, M.A., Maria Maceira-Lessley, Josie Torralba-Romero, M.S.W., Paula Stockdale, and Sharon Yokote. Subcommittee members alternated in serving as chairperson.

Ms. Caras distributed materials of consumer/survivor interest and described a forthcoming United Nations meeting on people with disabilities. Ms. Yokote described training in the Georgia model of peer support. Ms. Romero announced creation of the National Alliance of Ethnically Diverse Behavioral Health Associations, which will advocate for language access and accessibility to services for its representative groups, among other issues.

Old Business
Update on Vacancies. Chris Marshall, Consumer Affairs Specialist, CMHS, announced that Georgia's Director of Consumer Relations Larry Fricks has been appointed as a consumer member of the CMHS National Advisory Council and chair of the Subcommittee. Subcommittee members whose terms expire after the September meeting include Mr. Fitts, Ms. Lawrence, Ms. Romero, and Ms. Stockdale. Ms. Stockdale is eligible for reappointment.

Status of Recommendations. Mr. Marshall reported that the National Advisory Council accepted and forwarded the Subcommittee's briefing paper to the President's New Freedom Commission on Mental Health and that CMHS staff used the list of questions developed by the Subcommittee for interviews for the new CMHS director. The recommendation related to Ticket to Work was handled informally.

Dialogue with CMHS Acting Director
Gail P. Hutchings, M.P.A., reported that CMHS will name a new CMHS director imminently and stated her enthusiasm for Larry Fricks's participation on the Council and as chair of the Subcommittee. She acknowledged members' and CMHS staff's contributions in the agency's work. Among CMHS's recent activities have been dialogues among consumers and faith-based and community organizations, and among consumers with co-occurring issues and co-occurring service providers, researchers and policymakers. CMHS continues to focus on consumer protections related to seclusion and restraint and on its anti-stigma/anti-discrimination initiative.

Ms. Hutchings acknowledged Dan Fisher's contributions to the New Freedom Commission, whose final report will call for a fundamental transformation of the entire mental health system. The report will focus on six themes: mental health as essential to overall health, consumer- and family-centered care, eliminating disparities, early screening in multiple settings, best care science can offer, and investment in information technology. SAMHSA is mapping its resources and efforts under the six goals and will consider them priorities.

SAMHSA/CMHS's Eliminating Barriers Initiative works with states to develop and evaluate public education approaches designed to break down barriers to treatment and community participation for people with psychiatric disabilities; three of the eight target states have held kickoff meetings. SAMHSA/CMHS has begun to explore the feasibility of a consumer-directed self-determination initiative. The RFA for the National Consumer and Consumer/Supporter Self-Help Technical Assistance Centers will close on August 7.

Ms. Hutchings announced several personnel changes. New members of the CMHS National Advisory Council include Drs. Cheryll Bower-Stephens, Michael Vergare, Timothy Kelly, Larry Fricks and Ruth Edelman. Twenty-two new state mental health commissioners have taken office in the last year. New SAMHSA leaders include Deputy Administrator Jim Stone; Director Beverly Watts Davis, Center for Substance Abuse Prevention, and a new CMHS director. Three new branch chiefs and a new division director also will join CMHS. Ms. Hutchings acknowledged the contributions of Mike English, who has retired.

Discussion. Subcommittee members discussed using the term "discrimination (which relates to issues of prejudice) and stigma" instead of just the term "stigma" with Ms. Hutchings, who acknowledged the linkage and pledged balance in the use of both terms. She expects the Commission report to address anti-discriminatory and anti-stigma matters. Ms. Romero noted that ethnic communities experience stigma in addition to discrimination, and that resources to educate societies and cultures on stigma would be welcomed. Ms. Hutchings noted the necessity of education to embrace mental health as part of overall health.

Ms. Romero expressed concern about over-representation of people of color in the juvenile justice system. Ms. Hutchings stated that CMHS has entered an interagency agreement with the Office of Juvenile Justice and Delinquency Prevention to conduct a survey of programs serving youth at risk of entering the system. State teams, including consumers and families, will work with the Juvenile Justice and Mental Health Center, and NASMHPD will be involved. The Commission's report will address youth in juvenile justice systems.

Mr. Brock noted that stigma, has a segregating quality. He promoted the idea of developing a cadre of "consumer-providers" to provide an array of programs and services. The expertise of consumer-providers is grounded in personal experience with mental illnesses, treatment, and recovery, rather than solely in education. The concept would involve development of a workforce, programs, funding support, educational development, accreditation, certification, and support for consumer providers. Ms. Hutchings stated that CMHS will examine the Medicaid reimbursement model for peer support in Georgia.

Ms. Stockdale urged CMHS to establish training opportunities for consumers, family members, and agencies to enhance their cultural competence. The evidence base is insufficient in terms of proof of the effectiveness of cultural competence training; nevertheless, the best services available should be implemented.

Ms. Hutchings stated that the Alternatives Conference is planned for 2004. CMHS will establish cooperative agreements with technical assistance centers, instead of grants, to reflect increased CMHS involvement.

Mr. Fitts suggested the need for a CMHS partnership with states on self-determination. Ms. Hutchings stated that CMHS will examine a self determination initiative and the merit of dollars following individuals.

Ms. Romero urged focus on evidence-based practices for the consumer/family movement. Many families and individuals did not participate in the original research for which evidence has been developed. It is critical to evaluate consumer programs and learn why they work, and then to put these evidence-based practices forward. Ms. Hutchings noted that CMHS and the Commission have embraced the Institute of Medicine definition of evidence-based practice. It is important not to cut off services that have not yet caught up with the research. The National Registry for Effective Programs (NREP) now includes programs for substance abuse and co-occurring disorders, and soon will include mental health programs.

Ms. Hutchings reported that NASMHPD will present a Medicaid training institute for commissioners. Some federal funding opportunities will require state or local match, which helps sustainability, but some otherwise potential applicants will not apply because of the unavailability of funds to match. Ms. Romero noted that in California, 30 percent of the mental health resources will disappear this year and 25 percent next year. Consumers will be directed to hospitals, where the funding will be. Ms. Caras noted that CMS mental health director in Santa Cruz County, Rama Khalsa, has been successful in securing federal funding. Ms. Yokote explained the difficulties in transition from youth to adult services; the gap can be filled using peer supports. She noted the need for peer support career ladders. Ms. Hutchings noted that recovery will be emphasized in the Commission report, acknowledging the workforce crisis. Ms. Romero endorsed a spotlight on diversification of the workforce, workforce development, and leadership on the issue.

Ms. Hutchings stated that CMHS is collaborating productively with CMS and concurred with Mr. Brock that opportunities exist for effort on workforce issues. Mr. Brock discussed withdrawal of funding from Alabama's consumer advocacy program and issues related to accountability and transparency. Ms. Hutchings urged individuals to take the initiative in this situation, noting that CMHS can work with its National Advisory Council on trying to get authentic consumer participation.

Update on Assertive Community Treatment (ACT)
Elizabeth Edgar, M.S.W., Director, NAMI Consumer Supporter Technical Assistance Center.Both NAMI and the ACT Association's national conferences focused on ACT issues, particularly to increase consumer/family involvement. Work is a significant aspect of the ACT model. The most frequent calls to the technical assistance center focus on the location of the nearest team and on how to work with mental health authorities to find information. Ms. Romero urged investigating what in Latino (and other) communities is the equivalent of ACT. She expressed concern about serving monolingual clients who do not have access to full communication with case managers. A serious gap in ACT exists in housing and employment. Many consumers whose medications permit them to engage in fuller lives; but if they marry, they become ineligible for subsidized housing. Ms. Edgar acknowledged that housing is a major problem for ACT teams and persons with low incomes, an issue that NAMI is addressing. Some departments of mental health, including Florida and Los Angeles County, are providing or planning housing assistance in partnership with ACT teams. Mr. del Vecchio noted the existence of an Interagency Council on Homelessness, a joint funding initiative of SAMHSA and the Department of Housing and Urban Development, to end chronic homelessness.

Strategic Planning
Ms. Caras served as acting chair for this segment of the meeting. In a review of the subcommittee's operational guidelines, members discussed the following issues:

Allocate 30 minutes of discussion for each agenda topic. Staff will ask invited speakers to allocate half their time for discussion. The chair will monitor time. Agendas should reflect time for comments and questions. The subcommittee will review this guideline in June 2004.
Formal procedure for proxy votes will be reviewed in June 2004.
Orientation for new subcommittee members will take place prior to the winter meeting.
If possible, handouts will be made available to members prior to the meeting.
Staff will remind Council members that teleconferences are part of their responsibility.
Orientation of new members includes determining preferences for communication media.
Teleconference dates prior to the next subcommittee meeting will be set at the meeting.
Members can ask for accommodation if a problem exists with telephone access.

Mr. Marshall described the continual application process for members of the subcommittee. He maintains the files of applicants. An update on new applicants will be sent to subcommittee members. After the September meeting, the Council will replace Ms. Torralba-Romero. Appointment decisions are made by the CMHS director and the SAMHSA administrator.

Members discussed priority issues and how they relate to the key subject areas in the forthcoming Commission report; discussion of these areas and issues (and emerging issues) at forthcoming subcommittee meetings; training in cultural competence; consideration of the advocacy role and stakeholder partnerships when identifying existing gaps in order to eliminate disparities; establishing a meeting planning matrix that includes gaps, partnerships, and recommendations; Georgia's peer specialist program; information and technology (presentation by Ron Manderscheid); workforce issues, including significant volunteerism; public health perspective (the Institute of Medicine's Crossing the Quality Chasm); self-determination in directing one's own treatment and recovery; high- and low-tech approaches to the consumer sector; media education (Carter Center's Mental Health Journalism Program, Thom Bornemann); database on media coverage on mental health issues; and CMHS's scholarship policy for the consumer/survivor community; and coalition of consumer organizations and leadership (a possible track on the Alternatives Conference agenda).

Risa Fox explained the background of the Alternatives Conference as a technical assistance effort for consumer/survivors. The first Alternatives conference planned by a consumer technical assistance center took place in 1992, and since that time the conference has been planned, in rotation, among the consumer technical assistance centers. Members expressed concern that the name of the conference might change.

Recipients of CMHS scholarships for attendance at conferences file standard reports, which are handled by a CMHS contractor. Summary reports are used internally by CMHS. Ms. Caras suggested that a section might be added to the report form that could be used publicly. Scholarship opportunities should be posted on a CMHS webpage. Ms. Stockdale noted that in some rural areas, many consumers are unaware that scholarships exist. Mr. Marshall noted that scholarship information is disseminated widely by CMHS and the organizations sponsoring the meetings. Selection of recipients is as impartial as possible through a review process. CMHS' Consumer Affairs E-News also sends out scholarship announcements. Technical assistance centers might establish a website on conferences, agendas, and scholarship availability.

President's New Freedom Commission on Mental Health
Daniel B. Fisher, M.D., Ph.D., co-director of the National Empowerment Center, described his experiences as a commissioner self-identified as a consumer. He stated that he tried to make representation of consumers more than a token, bolstering his work by keeping the passion for what he believes in and by eliciting consumer input. He reminded commissioners, "I'm one, but I represent millions of people, and some people will be unhappy if these ideas don't get passed." He saw a big part of his task as educating most other commissioners about the consumer movement, which he tended to do in informal situations. He found that many on the commission were not that aware of recovery, so he invited many people to testify about their own experiences, and the educational exercise paid off.

Dr. Fisher established a commission subcommittee on consumer issues and Dr. Jean Campbell contributed to the Subcommittee's report. He also participated in the rights and engagement subcommittee. For the Council Subcommittee, he summarized an interim consumer issues paper, already in the public domain, that is likely to inform the final report.

Dr. Fisher's work on consumer issues informed the work of other Commission subcommittees, including housing, employment, evidence base, and cultural competence. He stressed the importance of sitting at the policy-making table and of communicating about the importance of qualitative and consumer-provided evidence. He also stressed use of personal testimony.

The vision articulated in the interim consumer-issues document reflects an expectation that people will recover from mental illnesses. Concepts discussed in the document include transformation of the mental health system into a community-based system of care, self-determination, empowering relationships, meaningful roles in society, and eliminating stigma and discrimination. The document states that people should have an opportunity to be involved, to sustain the process in the future, to ensure that other people will be boosted at other tables to have roles in policy making. The issues of housing, employment, and education received special attention. Other concepts promoted include establishment of a policy and research task force for consumer affairs; involving consumers and promoting recovery in all aspects of research design, conduct, and evaluation; funding a summer training institute for consumer mental health professionals to build their research and evaluation skills; and collaborative research.

Other themes were increased awareness of recovery and reduction of stigma and discrimination. Mr. Fisher reported that former First Lady Rosalynn Carter, a strong supporter of consumers, stated, "If our Commission had known that people could recover from mental illnesses, we would have written a completely different report." Additional principles include integrating peer support services into the continuum of community care, identifying and implementing financing mechanisms, and promoting interagency collaboration to better inform consumer choice.

Discussion. Dr. Fisher acknowledged the input that guided his work, including pushing for a separate consumer committee, planning ahead, keeping in mind the serenity prayer, choosing battles, and informal contacts. Ms. Romero echoed the importance of a support system and noted the risks of professionals self-identifying as consumers. She stated that the cultural competence movement must recognize that its strongest allies are families and consumers. Dr. Fisher noted that it will be necessary to spend money (for example, on job training) to diminish the rolls of people on Social Security disability. Significant problems remain with housing and Medicaid.

Mr. Fitts noted that taking consumers' messages beyond the medical community and to the larger audience may influence policy. Dr. Fisher concurred, noting that the system does not want to change itself; allies may be found among the public, insurance companies, and corporations. Dr. Fisher stated that SAMHSA will be one of the agencies that will carry out the Commission's recommendations. The greater disability community is another ally, and building bridges is as important as ever. For example, NIDA's purpose statement reflects the importance of self-determination, consumer control, and advocacy.

Dr. Fisher stated that including in the report the right to implement the Olmstead decision in a realistic fashion was controversial. Other rights included ending discrimination around employment for individuals with a history of mental illnesses in government, working toward elimination of seclusion and restraint, ending the practice of trading custody for treatment for kids, and parity. The Commission's website is www.mentalhealthcommission.gov.

HIPAA Consumer Education
Chris Marshall, described the provisions and significance of the 1996 Health Insurance Portability and Accountability Act (HIPAA). HIPAA establishes national standards for health records privacy and for electronic transactions and privacy of individually identifiable health information. Mr. Marshall described the covered entities and general principles of the privacy regulations, including the minimum necessary requirement for discussing records, the consent requirement, authorization for disclosing non-routine information, rights of access to records, amendments to records, and conditions under which sharing information is permitted. Information on HIPAA is available from the HHS Office for Civil Rights, www.hhs.gov/ocr/hipaa.

CMHS consumer education regarding HIPAA includes development of a consumer education card, and a consumer training video and supporting materials and a consumer focus group (in the planning stage). The card provides background on HIPAA, new individual rights, and who must follow the privacy rules. Ms. Maciera suggested convening a focus group in Spanish and printing the card in Spanish. Subcommittee input has been implemented in developing the card.

Laura Van Tosh, consultant, explained that a new industry has emerged in anticipation of HIPAA provisions to train providers. Medical patients will have unprecedented access to, and the ability to amend or correct, their own records, which can help consumers play a greater role in their recovery. Additional consumer activities may be forthcoming, including attention to cultural competence and plain language, and training for consumers. Ms. Van Tosh views HIPAA as strong patient's rights regulations, which consumers and advocates must find ways to use.

Discussion. Mr. Brock noted that by reviewing one's own records, one can see discrepancies between what was recorded and what that person experienced. Mr. del Vecchio explained that some exceptions are written into the regulations regarding psychiatric records. Mr. Marshall stated that the regulations provide for an appeals process if access is denied. HIPAA is meant to be a floor of protections, and states that have more stringent rules are not superceded by HIPAA. Subcommittee members identified language accessibility issues.

Public Comment
Karena Bayruns, Technical Assistance Coordinator, National Mental Health Consumers Self-Help Clearinghouse. The Clearinghouse hopes to continue to provide technical assistance to consumers. She applauded the increased involvement implied in a cooperative agreement with CMHS. She offered encouragement and support to Subcommittee members in how to provide more dialogue opportunities and to get feedback on CMHS programs.

Sue Bergeson, Vice President, Depression and Bipolar Support Alliance, acknowledged concerns in the consumer movement regarding language, encouraged Subcommittee members to consider how consumers can help move treatment guidelines into providers' hands, urged SAMHSA to centralize information about ethnically diverse resources, expressed the need for the field to know about programs that do not work and that should not be replicated, and offered DBSA's assistance in disseminating SAMHSA's information to its members.

Kathy Muscari, Director of Operations, Consumer Organization and Networking Technical Assistance Center. Ms. Muscari suggested that peer specialists could disseminate HIPAA information and address cultural competence issues. She noted that partnerships among consumer-related organizations and grassroots, local entities are important, as is people-first language. She urged emphasis on early education on consumer issues, particularly dissemination of consumer/survivor literature. She encouraged SAMHSA to provide more funding opportunities for people with psychiatric disabilities to attend relevant conferences.

The meeting recessed at 4:50 pm and reconvened on June 24, 2003, at 9:00 am.

Old Business: Approval of Minutes. The Subcommittee approved unanimously the minutes of its September 3-4, 2002, meeting.

Disabilities Advocate Cookie Gant Remembered. Subcommittee members and CMHS staff remembered the late Cookie Gant and her contributions. Subcommittee members voted unanimously to send a letter of recognition to her survivors.

Recommendations Review: Cross Disabilities and Seclusion and Restraint. Juli Anne Lawrence served as acting chair.
Paolo del Vecchio, M.S.W., Associate Director for Consumer Affairs, CMHS, introduced a discussion of recommendations, presented at the May 2002 subcommittee meeting, regarding self-identified needs of mental health consumer/survivors who have co-occurring physical disabilities. For future Council vacancies, Ms. Romero suggested that the Subcommittee seek and recommend persons with both physical and mental/emotional disabilities and to create alliances with other organizations to foster mental health consumer participation across disabilities and vice versa.

Mr. del Vecchio reported that SAMHSA released its National Action Plan at a May 5, 2003, National Call to Action to Eliminate the Use of Seclusion and Restraint. The use of seclusion and restraint has fueled years of debate on how people with mental health disabilities have been treated. Recent studies have shown that the practices can be dangerous and deadly. Children are at especially high risk, as are individuals with addictions or co-occurring issues, older adults, people of color, and individuals under involuntary treatment status. Use varies dramatically from facility to facility. Although some groups are developing guidelines for seclusion and restraint, training and technical assistance are needed to reduce and ultimately eliminate the practice.

The Children's Health Act established federal requirements, including training, for all health care and children's non-medical residential facilities. HCFA/CMS has published guidelines for reporting requirements for psychiatric hospitals and psychiatric treatment centers for children under 21. Advocacy groups have published position papers, and in 1999 Congress conducted a hearing on seclusion and restraint. Schools and juvenile justice facilities are among the institutions that use seclusion and restraint. SAMHSA Administrator Charles Curie's work in Pennsylvania dramatically reduced practices in state hospitals. SAMHSA funds the $32 million Protection and Advocacy Program (P&A), which investigates rights violations, including seclusion and restraint.

In partnership with public and private stakeholders, SAMHSA seeks to reduce and ultimately eliminate seclusion and restraint for all age groups in community-based and institutional behavioral health care settings by means of strategies involving data collection, evidence-based practices and guidelines, training and technical assistance, leadership and partnership development and rights protection. As examples of activity in support of these activities, CMHS has developed a performance indicator measure; NASMHPD, accreditation organizations, and CMS are compiling research on existing data systems; NASMHPD has sponsored regional trainings for state teams; the Child Welfare League of America (www.cwla.org) is identifying effective training programs; and the National Association of Consumer/Survivor Mental Health Administrators is developing a training curriculum for alternatives. Issues and strategies discussed during the Call to Action included staffing issues, consumer-specific activities such as consumer rights education, advance directives, guidelines for specific populations (hearing-impaired), and partnering with other agencies.

Discussion. Ms. Caras suggested future Subcommittee meetings focus on reducing forced treatment, reducing outpatient commitment, and emphasizing choice. Ms. Romero suggested linking licensing and certification to reduction/elimination of seclusion and restraint, in addition to education. Under reporting is a problem, particularly among monolingual individuals, children and adolescents, and in juvenile justice facilities and jails. Ms. Yokote suggested linking use of alternative practices to staff pay raises. In some settings, consumers in hospitals consent to videotaping of their agitated behavior to learn what makes them look dangerous to others. Ms. Lawrence suggested learning how Pennsylvania administers its model.

SAMHSA Priorities Matrix Reports: Community and Faith-Based Approaches
Captain John Tuskan, Senior Program Management Officer (Acting), CMHS Special Programs Development Branch, discussed SAMHSA activities related to the Faith-Based and Community Initiative, charitable choice, and the Compassion Capital Fund. The goal of the initiative is for governments not to discriminate against faith-based organizations in delivery of social services. Technical assistance is provided on education on writing grants and other tools to level the playing field to compete for federal dollars.

A series of executive orders created the White House Office of Faith-Based and Community Initiatives. Centers for Faith-Based and Community Initiatives have been established at the Departments of Education, HHS, Labor, Justice, HUD, Agriculture, and USAID. Federal agencies must treat religious and secular charities equally when awarding federal money, and FEMA may not prohibit religious nonprofits from getting disaster relief money.

The government has assumed a new role as supporter, enabler, catalyst, and collaborator with faith-based and community organizations to energize and rebuild social capital and overall to improve federal responses to need. The White House Office is working legislatively to broaden competition for funding opportunities; identifying and eliminating improper federal barriers to full participation; and encouraging greater corporate and philanthropic support.

Charitable choice, a legislative provision introduced by the Clinton Administration as part of welfare reform, is designed to remove barriers to the receipt of certain federal funds by faith-based organizations. The goal is to enable religious organizations to maintain their religious character without changing religious mission. It prohibits states from discriminating against religious organizations when choosing providers under certain federal grant programs. No new funding streams are dedicated to faith-based groups. Congress has authorized charitable choice for the Substance Abuse Prevention and Treatment Block Grant, substance abuse discretionary grants, and the PATH program.

The Compassion Capital Fund, a $30 million appropriation to the Administration for Children and Families, is the first federal appropriation of funds specifically targeted to assist the grassroots organizations that are the focus of the Faith-Based and Community Initiative. A national resource center and clearinghouse and 21 intermediary organizations provide technical assistance to grassroots groups in grant writing. Information on this program may be seen at www.samhsa.gov.

SAMHSA's three centers each have a work group on the initiative. Technical assistance in grant writing has been provided in 40 workshops to communities, an interfaith symposium was held SAMHSA-wide, and training will be conducted for HHS project officers.

Paulo del Vecchio described the CMHS-sponsored dialogue meeting held in October 2002 between consumer/survivor representatives and members of faith-based and community organizations, the fifth in a series of meetings between consumer representatives and representatives from service or provider organizations. Most consumers identified spirituality as an important aspect of their personal recovery, but some faith-based communities may not be that welcoming toward individuals with mental illnesses. Participants covered the spectrum of faith-based, ethnic, religious, and cultural groups; Dr. Basit was one of the participants. During the two-day dialogue, the group focused on many issues related to spirituality and promoting or hindering recovery on the individual and community levels. Positive influences of spirituality include a sense of community, rituals and spiritual practices, and the possibility to assist in understanding of disabilities and promote cultural competence. Forces that were identified that hinder recovery include discrimination and stigma in communities, lack of outreach to persons with mental illnesses, an authoritarian perspective, lack of openness, and the historical schism between religion and the mental health community.

Recommendations at the system level included providing education for faith-based and community organizations and for health and mental health care providers on the importance of spirituality for consumers and how it helps in recovery; ongoing dialogues and partnerships between the groups; and identification of best-practice models to engage people with mental health problems in faith-based communities. Faith-based organizations need to create supportive environments; provide instruction on mental health and mental illnesses in seminary education; address issues of discrimination and stigma, including clergy with their own mental health issues and related stigma and discrimination problems; engage chaplains in mental hospitals; encourage consumers and consumer advocates to share their stories to put a face on recovery; and establish speaker bureaus. Other recommendations included replicating the dialogue at the local level within faith-based organizations and mobilizing consumer groups to provide information to clergy.

Discussion. Ms. Romero noted that consumers and family members are the best teachers of future providers about the importance of spirituality in mental health. Guilds must identify the need to teach this subject matter and identify who is best to teach it. Ms. Caras recommended that dialogues be included in NREP. She identified the unhelpful practice within the psychiatric field of medicalizing spirituality. Capt. Tuskan noted that the DSM-IV corrected the "religious faux pas" in DSM-III, but Ms. Romero observed that this correction has not been operationalized which is a potential focus of ongoing cultural competence training. Mr. Brock noted that the consumer/survivor movement can be a way to experience being a person, rather than a diagnosis, and a link with spirituality can be important in this regard. Mr. del Vecchio commented that faith groups can be similar to the consumer/survivor movement in their sense of community and of belonging, of being a person; in the provision of personal supports; and in the faith and hope that each can provide. Capt. Tuskan noted that spirituality and faith could give meaning to suffering that behavioral science cannot answer. Mr. Fitts observed that in some settings, discussion is discouraged about spirituality. Mr. del Vecchio pointed out that when people experience mental health problems, they usually seek help initially from family, friends, religious leaders, and then from mental health providers. Faith-based organizations provide basic services, such as housing, jobs, and clothing. Participants at regional consumer meetings say that faith and community groups can help fill these needs.

Strategic Planning
Members categorized the issues identified in their prior brainstorming session into the six anticipated goals of the New Freedom Commission's report:

Mental health is essential to health: funding, Medicaid reform, national consumer organization funding, support for school and college (supported education), vouchers regarding self-determination (cash and counseling), One Health and Human Services, CMHS handbook on Social Security disability benefits
Consumer and family-driven care: Consumer participation is valuable, disparities in service delivery, cultural competence, consumer-run programs and services/certification and accreditation, national consumer organization funding
Eliminate disparities: training for multicultural groups
Early identification/intervention
Provide the best care science can offer/relevant research
Access to technology and training

Agenda Items for Future Meetings
The September meeting will focus on information/communication technology and consumer and family-driven care. Mr. Brock suggested investigating federally funded computer purchases that do not meet the needs of users with disabilities and that impose unanticipated financial burdens, suggesting that disability-run organizations be providers of these programs at little or no cost to individuals who access them, taking into consideration cultural competence, literacy levels, language access, accessibility to people with low vision, dissemination to the grassroots, and access to telephones. Other agenda items might include pre-symptomatic interventions (as in autism) and children's rights.

National Advisory Council Agenda and Recommendations. The subcommittee passed unanimously the following recommendations to the National Advisory Council:

1. In recognition of the importance of meaningfully involving Americans with various disabilities and to promote cross-disability collaboration and attention to cross-disability issues, SAMHSA/CMHS is encouraged to conduct outreach to such individuals and include their appointment to the SAMHSA/CMHS National Advisory Council.

2. In accordance with the current Self-Help Technical Assistance Center Request for Applications (RFA), SAMHSA/CMHS is strongly encouraged to continue - past the RFA's one-year commitment - to fund and support the national mental health consumer technical assistance conference entitled "Alternatives" and to retain its respected, time-honored name and to maintain that the event is consumer planned and managed.

A discussion of Social Security Administration regulations was tabled.

Public Comment. Yvonne Smith spoke about the importance of the Alternatives Conference and retaining its name. Jon Brock formally remembered the late Cookie Gant.

Adjournment and Upcoming Meetings. The meeting adjourned at 2:00 pm. The next subcommittee meeting will take place September 2-3, 2003. The next CMHS National Advisory Council meeting is scheduled for September 4-5, 2003. Subcommittee teleconferences will take place on the afternoons (Eastern time) of July 23 and August 13, 2003. Nominations for new subcommittee members will be discussed on August 13.