Posted on May 25, 2000
The National Alliance for the Mentally (NAMI) is pleased to support the legislation introduced today by Senators Pete Domenici (R-NM) and Ted Kennedy (D-MA) to provide for greater treatment of mental illnesses.
The purpose of the legislation is to save lives-by reducing suicides and tragic episodes of violence. It is intended to help people who need help the most, before tragedies occur.
Mental illnesses such as major depression or schizophrenia are biological brain disorders. According to the U.S. Surgeon General, one in five Americans experience a mental disorder every year, but "critical gaps exist between those who need service and those who receive service" as well as between "optimally effective treatment and what many individuals receive in actually practice settings." This legislation will help close those gaps.
Suicide exists as a public health crisis. Some 30,000 Americans commit suicide each year. Even more alarmingly, suicide is the third leading cause of death for children and adolescents. Ninety percent of all suicides involve mental illness. This legislation will help prevent suicides.
Effective treatments exist. The treatment success rate for schizophrenia currently is 60 percent; for major depression, 65 percent; and for bipolar disorder (manic-depression) 85 percent. In each case, the rate is higher than that for heart disease. Unfortunately, many people with these brain disorders do not get the treatment they need. This legislation will help to promote treatment.
NAMI notes the importance especially of provisions, which seek to reverse the criminalization of mental illness. More than 250,000 individuals with mental illnesses today reside in American prisons and jails. They are being warehoused at a cost far greater to taxpayers than if early interventions and treatment had been provided.
Too many people with mental illness die from lack of adequate treatment. They frequently become homeless, abuse illegal drugs, or commit petty crimes. In some cases, they are being shot by police who lack specialized training or support from the mental health system. In response, the legislation provides:
Furthermore, the legislation provides for the development or expansion of community-based treatment focused in two distinct areas: individuals with co-occurring mental illness and addictive disorders, and "emerging or urgent" mental health service needs.
NAMI applauds the legislation for requiring that programs for individuals with co-occurring mental illness and addictive disorders be based on integrated treatment models. The evidence is clear. Only integrated treatment succeeds for co-occurring disorders. Parallel or serial programs do not work. Unfortunately, the Senate earlier this year, as part of the Substance Abuse & Mental Health Services Administration (SAMHSA) reauthorization, failed to give states the discretion to blend mental health and substance abuse block grant funds to support integrated programs. Congressional emphasis on integrated treatment is urgently needed, and this legislation is an important step in the right direction.
The legislation also establishes priorities for "emerging or urgent" needs. For adults, treatment priority is based on:
For children and adolescents, the priority is for those at risk of:
NAMI also notes two other sections of the bill. In the treatment of mental illnesses, a crucial factor is whether or not a person regularly takes prescribed medication. As with other illnesses, taking medication sometimes makes a difference between life and death.
As with other illnesses, "medication compliance" also can be a problem for people with mental illness. Sometimes, individuals become so sick that they lose the ability to think clearly and rationally. In other instances, they may begin to feel better and discontinue medication in the mistaken belief that they have recovered.
Unfortunately, not taking medication sometimes leads to violence. Such cases are relatively rare, but noncompliance literally can mean the difference between life and death for a person with mental illness, family members, friends, or other members of the community.
NAMI therefore strongly supports the section of the bill establishing a Treatment Compliance Initiative: a research program led by the National Institute of Mental Health (NIMH) to determine those factors that contribute to noncompliance with outpatient treatment plans-and to seek "innovative, community-based programs that use non-coercive methods to enhance compliance."
Ideally, the best compliance is voluntarily, but NAMI recognizes that involuntary treatment sometimes may be necessary as a last resort. We therefore also strongly support the bill's provision for a Commission to study issues involved in involuntary treatment; existing laws governing such treatment; and if appropriate, to recommend model legislation to regulate it.
The proposed Commission provides a basis for dialogue about involuntary treatment, without presupposing any outcome. Over 40 states currently have outpatient commitment laws. Some are viewed as too weak. Others may exist in a vacuum, without guarantees of adequate treatment. Some may lack standards or safeguards. It therefore is appropriate that a federal inquiry be undertaken.
This legislation contains many significant provisions. Overall, it will move the nation forward in confronting many of the failures of the current mental healthcare system, as well as limitations in the criminal justice system. It provides an important catalyst for change at a time when reforms are urgently needed.
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