National Alliance on Mental Illness
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  Where We Stand

Surgeon General’s Report on Mental Illness Affirms NAMI’s Mission

NAMI’s Position: (Summarized from NAMI’s Public Policy Platform)

NAMI is a grassroots organization of individuals with brain disorders and their family members whose mission is to eradicate brain disorders and improve the quality of life of persons of all ages who are affected by them. NAMI identifies as the priority population those persons of all ages who have severe and persistent mental illnesses.

The Report’s Major Findings

The U.S. Surgeon General’s historic Report on Mental Health, released in December 1999, differentiates between mental illness and other mental health situations. Mental illnesses are mental disorders that are diagnosable and are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning. Mental health is healthy thinking, communication, learning, emotional growth, resilience, and self-esteem. This differentiation, on page one of the report, is a helpful reminder of the difference between enhanced quality of life and brain disorders which seriously interferes with life functioning.

David Satcher, M.D., Ph.D., the Surgeon General, declares that most mental illnesses can be successfully treated, either in terms of stabilization or recovery. The nation’s scientific institutions have documented much about the basic workings of the brain and have translated new knowledge into clinically relevant treatment interventions. NAMI applauds Dr. Satcher’s leadership in issuing this historic report and in affirming the science base of treatment.

The Surgeon General’s Report on Mental Health affirms several core principles underlying NAMI’s public policy approach. These include:

Neuroscience and Neurochemistry Underlies Mental Illness

"The brain has literally thousands of different kinds of neurons, each distinct in terms of chemistry, shape, and connections…The workings of the brain depend on the ability of nerve cells to communicate with each other." (pg. 32-33)

"Superimposed on this breathtaking structural complexity is the chemical complexity of the brain" where a "neurotransmitter can elicit a biological effect" in neurons. (pg. 36)

"There are far-reaching biological and physical influences on mental health and mental illness." (pg. 52)

"The past decade has seen an outpouring of new drugs introduced for the treatment of mental disorders." (pg. 68)

Mental Illness is Treatable

"Mental disorders are treatable, contrary to what many may think. An armamentarium of efficacious treatments is available to ameliorate symptoms." (pg. 64)

The Hope of Recovery

The Surgeon General (page 97) observes that "Recovery is variously called a process, an outlook, a vision, a guiding principle. There is neither a single agreed-upon definition of recovery nor a single way to measure it. But the overarching message is that hope and restoration of a meaningful life are possible, despite serious mental illness."

Family Self Help Is Important

"Families—especially parents, siblings, adult children, and spouses—often provide housing, food, transportation, encouragement, and practical assistance. At the same time, schizophrenia and other mental disorders strain family ties. Symptoms of mental disorders may be disruptive and troubling, especially when they flare up. Even when there are no problems, living together can be stressful—interpersonally, socially, and economically." (pg. 241)

"Consequently, families too have created support organizations…Similar to self-help among people with mental illnesses, family self-help can range from small supportive groups to large organizations. The National Alliance for the Mentally Ill (NAMI) is the largest of such organizations." (pg. 291-292)

Consumer Self Help Is Vital

"Self-help is based on the premise that people with a shared condition who come together can help themselves and each other to cope, with the two-way interaction of giving and receiving help considered advantageous. Self-help groups are peer led rather than professionally led." (pg. 289)

"A number of controlled studies have demonstrated benefits for consumers participating in self-help." (pg. 290)

"Propelled by the growing consumer movement, consumer self-help extends beyond self-help groups. It also encompasses consumer-operated programs, such as drop-in centers, case management programs, outreach programs, businesses, employment and housing programs and crisis services, among others." (pg. 290)

Health Benefit Restrictions and the Need for Parity

"Mental health benefits are often restricted through greater limits on their use or by imposing greater cost-sharing than for other health services…Studies show that the gap in insurance coverage between mental health and other health services had been getting wider." (pg. 426-427)

"’Parity’ refers to the effort to treat mental health financing on the same basis as financing for general health services…The fundamental motivation behind parity legislation is the desire…to cover mental illness fairly." (pg. 426)

"Financial obstacles discourage people form seeking treatment and from staying in treatment…There is an enormous disparity in insurance coverage for mental disorders in contrast to other illnesses. Mental health coverage often is arbitrarily restricted…Recent legislative efforts to mandate equitable insurance coverage for mental health services have been heralded as steps in the right direction for reducing financial barriers to treatment." (pg. 457)

The Nation’s Fragmented Hybrid System Fails Persons With Serious Mental Illnesses

The nation’s "hybrid system" of fragmentation status quo defense must be overhauled with an omnibus, multi-strategy series of initiatives which focus exclusively on persons with the most severe and persistent mental illness. The Surgeon General declares that "many mental disorders are best treated by a constellation of medical and psychosocial services, it is not just the services in isolation, but the delivery system as a whole, that dictates the outcome of treatment." (page 285)

"Integrating the range of services needed by individuals with severe and persistent mental disorders has been a vexing problem for decades. Integrating service systems remains a challenge to mental health and related human service agencies. Its benefits for accountability and centralization of authority have been established. Its impact on individuals with severe and persistent mental illness may be limited by the lack of available high quality services and mainstream welfare resources, reflecting the gap between what can be done and what is available."(pg. 295)

Successful Treatment Requires Social Supports

As the Surgeon General observes, (page 285): "Effective service delivery also requires support from the social welfare system in the form of housing, job opportunities, welfare, and transportation."

Integrated Treatment Is Necessary For Persons With Co-Occurring Mental And Addictive Disorders

The nation must develop accessible integrated treatment programs for the 10-to-12 million persons with co-occurring mental and addictive disorders. As the Surgeon General declares, (page 288): "Decades of treating co-morbidity through separate mental health and substance abuse service systems proved ineffective."


Surgeon General’s Report on Mental Health: A Focus on Children

NAMI Position (Summarized from the NAMI Policy Platform):

NAMI believes that all children and adolescents with brain disorders deserve to have early diagnoses with appropriate treatments and services targeted to their specific needs.

The Surgeon General’s Report on Mental Health affirms several core principles underlying NAMI’s public policy approach. These include:

Families as Essential Partners

"Families have become essential partners in the delivery of MH services for children and adults." (pg. 193)

Family support is assistance given to families to cope with the extra stresses that accompany caring for a child with emotional disabilities. "The main goal of family support services is to strengthen adults in their roles as parents, nurturers, and providers. Too often, family support services are not available within local communities."(pg. 188)

Biological Factors Significant to Serious Childhood Mental Illness

"Increasing consensus has emerged that biological factors exert especially pronounced influence on several disorders in particular, including pervasive development disorder, autism, and early onset schizophrenia." (pg. 129)

"It is also likely that biological factors play a large part in the etiology of social phobia, obsessive-compulsive disorder, and other disorders such as Tourette disorder." (pg.129)

"Biological influences are not necessarily synonymous with those of genetics or inheritance…can be caused by injury, infection, poor nutrition, or exposure to toxins…" (pg. 129)

"Mental disorders that are most likely to have genetic components include autism, bipolar disorder, schizophrenia and attention–deficit/hyperactivity disorder."

Lack of Treatment Predominates

"One might find a well-supported, innovative array of mental health services for children in one state or community, and almost no services in the next." (pg. 183)

Systems Failures Contributes To Lack of Treatment

"The system for delivering mental health services to children and their families is complex, sometimes to the point of inscrutability – patchwork of providers, interventions, and payers." (pg. 179)

Child Psychiatrists Are Needed

"There is a dearth of child psychiatrists, appropriately trained clinical child psychologists, or social workers." (pg.138)

How To Obtain Copies:

To obtain a copy of the Surgeon General’s Report on Mental Health, please call 1-877-9-MHEALTH or click here to access online version of report and other related information. For general information from the Surgeon General, please visit the Surgeon General's website

For more information about NAMI’s activities on the overall strategy of the report, please contact NAMI's Public Policy Department at 703-524-7600. For more information on this report as it applies to children, please call Patricia Braun at 703-600-1110. All media representatives, please call NAMI’s communications staff at 703-312-7893.