Interim Report of the President's New Freedom Commission on Mental Health

The President's New Freedom Commission on Mental Health was established as part of the President's agenda to ensure that Americans with mental illness not fall through the cracks, that lives not be lost, and that recovery be a realistic goal of treatment. The Commission is essential to the President's commitment—embodied in the New Freedom Initiative—to eliminate inequality for Americans with disabilities.

President George W. Bush asked the Commission in April of 2002 to recommend improvements in the U.S. mental health service system for adults with serious mental illness and for children with serious emotional disturbances. He requested a review of both public and private sectors to identify policies that could be implemented by Federal, State, and local governments to maximize the utility of existing resources, to improve coordination of treatments and services, and to promote successful community integration.

While the Commission's recommendations will be presented in its final report in April 2003, this document responds to the legal requirement for an interim report (Executive Order 13263):

Sec. 6 (a) Interim Report. Within 6 months from the date of this order, an interim report shall describe the extent of unmet needs and barriers to care within the mental health system, and provide examples of community-based care models with success in coordination of services and providing desired outcomes.

The Commissioners are highly motivated to respond to the President's charge. Through monthly meetings, the Commission has reached out to consumers of mental health care, families, advocates, public and private providers, administrators, and researchers. The Commission has received public comments by personal testimony, letters, and an Internet web site. Individuals throughout the country have shared their experiences and offered suggestions on ways to improve mental health service delivery. The Commission held a meeting in Chicago to grasp firsthand the challenges that youth and families face, and it plans to hold meetings elsewhere in the United States. The Commission has asked experts in mental health care to evaluate various aspects of mental health services and to offer recommendations for improvement.

After several months of hearing from the public, the Commission affirms the President's position that Americans deserve a health care system that treats their mental illnesses with the same urgency as it treats their medical illnesses. In an ideal system, all individuals would receive prompt, high quality, effective care with the same priority, regardless of diagnosis.

The Commission is united in the belief that the mental health service delivery system needs dramatic reform. It is becoming clear that the mental health services system does not adequately serve millions of people who need care. While many consumers do receive effective treatments and services, many others do not. The system is fragmented and in disarray—not from lack of commitment and skill of those who deliver care, but from underlying structural, financing, and organizational problems. Many of the problems are due to the "layering on" of multiple, well-intentioned programs without overall direction, coordination, or consistency. The system's failings lead to unnecessary and costly disability, homelessness, school failure, and incarceration.

This interim report first describes the Commission's findings about the extent of unmet needs and the barriers to care. For each barrier, the Commission then spotlights one or more community-based models with proven success in coordinating services and producing desired outcomes. The Commission will further examine these models as part of potential solutions for the mental health system.

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