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American Psychiatric Association Unveils Blueprint to Save America's Crumbling Mental Health System

Vision for Mental Health System Report Offers 12 Guiding Principles to Reform, Rebuild System

Arlington, VA -- April 3, 2003 -- The American Psychiatric Association unveiled today a far reaching blueprint to reform and rebuild our crumbling mental health system-A Vision for the Mental Health System-amidst the deepening funding crisis in state and local mental health services.  The report was prepared by a blue-ribbon task force of psychiatrists from the public and private system.

APA President Paul S. Appelbaum, M.D., in a stinging assessment of our nation's mental health system, noted that deeper cuts in mental health services, particularly in state Medicaid programs, are leading to a "wholesale collapse of our mental health system."

Dr. Appelbaum emphasized that APA's Vision report "lays out a set of principles to rebuild and reform our mental health system, and provide a system of care for our most vulnerable citizens."

Mental disorders causing distress and dysfunction affect nearly 1 in 5 adult Americans in any given year. Nearly 3% of American adults are severely and persistently mentally ill and the majority of these patients depend upon Medicaid and state mental health services for their care. Today, Medicaid provides care for more than 60 percent of people with schizophrenia.

Task Force Chair, Steven S. Sharfstein, M.D., said that "2003 is a watershed year for mental health because for the first time in more than 30 years, a Presidential Commission is focusing on this crisis, and the U.S. Congress is seriously considering a law to equalize insurance coverage for mental illness and other medical conditions."

Dr. Sharfstein noted that APA's mental health blueprint was prepared in anticipation of the Final Report of  the President's New Freedom Commission on Mental Health  due in late April which "we hope will include many of the 12 critical principles for our mental health system" outlined in the document Vision for Our Nation's Mental Health System (PDF, 69KB).

The Twelve Principles for a Vision for Our Nation's Mental Health System are: 

  1. Every American with psychiatric symptoms has the right to a comprehensive evaluation and an accurate diagnosis which leads to an appropriate, individualized plan of treatment.
  2. Mental health care should be patient and family centered, community based, culturally sensitive, and easily accessible without discriminatory administrative or financial barriers or obstacles.
  3. Mental health care should be readily available for patients of all ages, with particular attention to the specialized needs of children, adolescents, and the elderly. Unmet needs of ethnic and racial minorities require urgent attention.
  4. Access to mental health care should be provided across numerous settings, including the workplace, schools, and correctional facilities. An emphasis should also be placed on the early recognition and treatment of mental illness.
  5. Patients deserve to be treated with dignity and respect. When they are clinically able they are entitled to choose their physician or community-based agency and to make decisions regarding their care.
  6. Patients deserve to receive care in the least restrictive setting possible that encourages maximum independence with access to a full continuum of clinical services, including emergency/crisis, acute inpatient, outpatient, intermediate level, and long-term residential programs.
  7. Since mental illness and substance abuse occur together so frequently, mental health  care should be fully integrated with the treatment of substance abuse disorders and with primary care and other general medical services.
  8. Support must expand for research into the etiology and prevention of mental illness and into the ongoing development of safe and effective treatment interventions.
  9. Efforts must be intensified to combat and overcome the stigma historically associated with mental illness through enhanced public understanding and  awareness.
  10. Health benefits, access to effective services, and utilization management must be the same for people with mental illness as for other medical illnesses, preferably funded by integrated financing systems. Although states are the ultimate locus of responsibility for the public safety net, the federal government and the private sector employers  must also support an increased investment in the mental health of Americans.
  11. Funding for care should be commensurate with the level of disability caused by a psychiatric illness. Disability occurs both in the severely and persistently mentally ill and in patients with other unforeseen psychiatric conditions who suffer despite having previously been productive and functional.
  12. More resources should be devoted to treatment and to training an adequate supply of psychiatrists, especially child psychiatrists, to meet the current and future needs of the population.

Members of the task force include: Steven S. Sharfstein, M.D.; Chair, Paul S. Appelbaum, M.D.; Norman A. Clemens, M.D.; Anita S. Everett, M.D.; David Fassler, M.D.; Susan L. Padrino, M.D.; Roger Peele, M.D.; Darrel A. Regier, M.D.; Michelle B. Riba, M.D.

The American Psychiatric Association is a national medical specialty society, founded in 1844, whose 35,000 physician members specialize in the diagnosis, treatment and prevention of mental illnesses including substance use disorders. For more information, visit the APA Web site at