NAMI’s Position (Summarized from the NAMI Policy Platform)
Treatment, not punishment:
NAMI believes that persons who have committed offenses due to states of mind or behavior caused by a brain disorder require treatment, not punishment. NAMI believes that a prison or jail is never an optimal therapeutic setting. NAMI believes that mental health systems have an obligation to develop and implement systems of appropriate care for individuals whose untreated brain disorders may cause them to engage in inappropriate or criminal behaviors.
Treatment while in correctional settings:
NAMI believes that states and communities have legal and ethical obligations to provide people with brain disorders humane and effective treatment while in correctional settings.
Training and education:
NAMI believes that education about brain disorders at all levels of judicial and legal systems is crucial to the appropriate disposition of cases involving offenders with brain disorders. Judges, lawyers, police officers, correctional officers, parole and probation officers, law enforcement personnel, court officers, and emergency medical transport and service personnel should be required to complete at least 20 hours of training about these disorders. Consumers and family members should be a part of this educational process.
NAMI believes that, in the overwhelming majority of cases, dangerous or violent acts committed by persons with brain disorders are the result of neglect or inappropriate or inadequate treatment of their illness.
NAMI supports the retention of the "insanity defense" and favors the two-prong test that includes the volitional as well as the cognitive standard. NAMI opposes the adoption of "guilty but mentally ill" statutes. NAMI supports systems that provide comprehensive, long-term care and supervision in hospitals and in the community to individuals found "not guilty by reason of insanity," "guilty except for insanity, or any other similar terminology used in state statutes pertaining to the insanity defense.
Parole and probation, transitional services:
NAMI believes that states must adopt systems for assisting individuals with serious brain disorders who have served sentences and are eligible for release on parole with appropriate treatment and services to aid their transition back into the community.
NAMI opposes the death penalty for persons with brain disorders.
The "Criminalization" Trend Is Today Worse Than Ever
In 1992, NAMI and Public Citizen’s Health Research Group released a report, entitled Criminalizing the Seriously Mentally Ill: The Abuse of Jails as Mental Hospitals, which revealed alarmingly high numbers of people with schizophrenia, bipolar disorder, and other severe mental illnesses incarcerated in jails across the country. Most of these people had not committed major crimes, but either had been charged with misdemeanors or minor felonies directly related to the symptoms of their untreated mental illnesses, or had been charged with no crimes at all. Unfortunately, the problems described in that report have worsened in the ensuing years.
A report issued by the United States Department of Justice in 1999 revealed that 16 percent of all inmates in state and federal jails and prisons have schizophrenia, manic depressive illness (bipolar disorder), major depression, or another severe mental illness. This means that on any given day, there are roughly 283,000 persons with severe mental illnesses incarcerated in federal and state jails and prisons. In contrast, there are approximately 70,000 persons with severe mental illnesses in public psychiatric hospitals, and 30 percent of them are forensic patients. Additionally, police are increasingly becoming front-line respondents to people with severe mental illnesses experiencing crises in the community.
Conditions in jails and prisons are often terrifying for people with severe mental illnesses. These settings are not conducive to effectively treating people with these brain disorders. Many correctional facilities do not have qualified mental health professionals on staff to recognize and respond to the needs of inmates experiencing severe psychiatric symptoms. Correctional facilities frequently respond to psychotic inmates by punishing them or placing them in physical restraints or administrative segregation (isolation), responses that may exacerbate rather than alleviate their symptoms. Inmates with severe mental illnesses usually do not have access to newer, state-of-the-art, atypical antipsychotic drugs because of the costs of these medications. Federal and state prisons generally do not have adequate rehabilitative services available for inmates with severe mental illnesses to aid them in their transition back into communities.
These alarming trends are directly related to the inadequacies of community mental health systems and services. The widespread adoption of systems with proven effectiveness in addressing the needs of people with the most severe mental illnesses, such as assertive community treatment programs, would sharply decrease the numbers of people with severe mental illnesses involved in criminal justice systems.
However, since these programs are available only sporadically throughout the country, NAMI’s strategies for reducing criminalization focuses both on improving community mental health services and on addressing the treatment and support needs of people with severe mental illnesses in criminal justice systems.
Strategies for Reducing the Criminalization of People with Severe Mental Illnesses:
NAMI is pursuing the following strategies for reducing the criminalization of people with severe mental illnesses:
Adopting programs such as the Memphis Police Crisis Intervention Team (CIT) program to train police officers who come into contact with people with severe mental illnesses in the community to recognize the signs and symptoms of these illnesses and to respond effectively and appropriately to people who are experiencing psychiatric crises.
Supporting mechanisms to divert people with severe mental illnesses from arrest and incarceration into treatment before they are arrested and come into contact with correctional and court systems. In FY 2002, Congress appropriated $4 million for the federal Jail Diversion program at the Center for Mental Health Services (CMHS) authorized under P.L. 106-310 (Section 520g). NAMI urges full funding of $10 million for this program in FY 2003.
Creating authority in state criminal codes for judges to divert non-violent offenders with severe mental illnesses away from incarceration into appropriate treatment. This includes authority for judges to defer entries of judgment pending completion of treatment programs and to dismiss charges and expunge the records of individuals who successfully complete treatment programs.
Establishing specialty "mental health courts" to hear all cases involving individuals with severe mental illnesses charged with misdemeanors or non-violent felonies, with the purpose of diverting as many of these cases as possible away from criminal incarceration into appropriate mental health treatment and services. In 2000, Congress enacted and former President Clinton signed into law a bill (P.L.106-515) authorizing grants to communities to establish demonstration mental health courts. In fiscal year (FY) 2002, Congress appropriated $4 million for these Courts. One of NAMI’s priorities is to ensure that Congress appropriates full funding of $10 million for these Courts as part of the FY 2003 Commerce-Justice-State Appropriations bill.
Training probate, civil, and criminal court judges and other Court personnel about severe mental illnesses and legal issues affecting people with these illnesses.
Creating specialized divisions or units within departments of parole and probation with specific responsibility for coordinating and administering services for people with severe mental illnesses who are on probation.
Providing specialized training to parole officers about severe mental illnesses, the needs of people with these illnesses on probation, and treatment resources and benefits available to these individuals.
MEDICARE COVERAGE OF MENTAL ILLNESS TREATMENT
NAMI strongly supports congressional efforts to modernize coverage of mental illness treatment under the Medicare program – specifically to address the discriminatory aspects of programs such as the 50 percent co-payment requirement for outpatient mental illness treatment and a 190 day lifetime limit on inpatient hospitalization. NAMI supports the following bills in Congress to address these other inequities in Medicare: HR 599, S 841, S 690 and HR 1522,
NAMI strongly supports bipartisan efforts in Congress to add a prescription drug benefit to the Medicare program that provides adequate protections against the high cost of medications, ensures eligibility for both senior citizens and non-elderly people with disabilities on SSDI and does not administer benefits through use of restrictive formularies.
Parity Under Medicare
Medicare coverage of mental illness treatment has remained virtually unchanged since the program’s inception in 1965. This coverage continues to impose stigma-based distinctions in coverage between mental illness and other medical treatment. Medicare beneficiaries must pay 50 percent of the cost of outpatient mental illness treatment, as opposed to 20 percent for all other outpatient services. Similarly, Medicare imposes a 190-day lifetime limit on inpatient psychiatric hospitalization that is not imposed on all other inpatient treatment.
NAMI strongly supports various bills now before Congress to address these historic inequities in the Medicare program. Among these are HR 599 (Roukema), S 841 (Snowe/Kerry), S 690 (Wellstone) and HR 1522 (Stark) and urges the Bush Administration and Congress to incorporate them into efforts to enact comprehensive restructuring of the program.
Outpatient Prescription Drug Coverage Needed
Both President Bush and congressional leaders have pledged to make coverage of outpatient prescription drugs part of the Medicare program. This issue has been commonly framed as "coverage of prescription-drug benefits for seniors." Much to NAMI’s regret, few elected officials have discussed this popular issue in terms of providing such coverage for the 1.3 million non-elderly people with disabilities who are eligible for Medicare by virtue of having been on Social Security Disability Insurance (SSDI) for a minimum of two years.
Later this year, Congress is expected to take up several competing measures to add a prescription drug benefit to Medicare. All of these competing plans agree on the need for any Medicare drug benefit to be universal (all Medicare beneficiaries would be eligible for the benefit) and an entitlement. Further, all of the competing plans include some type of "stop loss" coverage – establishing a threshold above which all costs are covered (ranging from as low as $3,500, up to $7,000 in competing bills).
The separate House and Senate bills vary widely on several critical issues: a) costs and b) whether the program should be administered within the existing structure of the Medicare program (generally favored by Democrats) or through private sector plans (generally favored by President Bush and Republicans). On the issue of costs, proposals vary from as low as $200 billion over 10 years, up to more than $750 billion over 10 years. Because of the looming retirement of the large baby-boom generation, putting off enactment of a drug benefit raises the eventual costs by as much as 18% a year.
On the issue of program structure and delivery, a leading proposal authored by Senate Democratic leaders would add a new Part D to Medicare would administer a new prescription drug benefit through the existing Medicare structure. By contrast, a proposal being pushed by House Republican leaders would direct insurance companies and HMOs to offer prescription-drug coverage. This new benefit would be enacted in conjunction with larger, systemic reform of the entire Medicare program. Under this legislation, the government would not directly provide drug coverage, purchase drugs, or regulate prices. Instead, private health plans would be expected to offer a variety of options that would include drug coverage integrated into Medicare as well as "drug only" coverage added to the traditional Medicare program. These private plans would be expected to pass discounts to beneficiaries based on a federal subsidy for the premium costs for drug coverage. Other proposals would rely on Pharmacy Benefit Management (PBM) providers to administer a new drug benefit and penalize manufacturers that refuse to discount drug prices.
On the issue of restrictive prescription-drug formularies, most of the competing congressional proposals attempt to respond to Medicare-enrollee frustrations about access to the newest and most effective medications. Most proposals would bar the establishment of a uniform national formulary for any class of FDA-approved drugs. At the same time, each proposal either explicitly or implicitly assumes that insurers will be able establish their own formularies and each will have a process to allow beneficiaries to appeal decisions to deny non-formulary drugs.
As part of the debate over Medicare prescription drug coverage, NAMI supports the following principles:
prescription drug coverage must address the underlying discrimination in Medicare’s existing, overall mental illness benefit,
the 1.3 million non-elderly persons receiving SSDI benefits (25 percent of whom are eligible for SSDI because of a mental illness) must be eligible on the same terms and conditions as elderly beneficiaries),
coverage should be a standardized with entitlement for all eligible Medicare recipients,
coverage must be sufficient enough to pay for the most expensive drugs for the treatment of severe and persistent mental illnesses and include "stop loss" coverage, and
prescription drug formulary policies must adhere to a principle of open access to the newest and most effective medications for serious brain disorders such as schizophrenia, bipolar disorder and major depression.
NAMI Housing Fact Sheet
NAMI supports efforts to increase funding in FY 2002 for the HUD Section 811 program (above its current $241million level) and to maintain the integrity of the capital-advance and project-based rental-assistance portion of the program (maintaining the existing 75 percent threshold). For the 25 percent of the Section 811 program that HUD directs to tenant-based rental assistance, NAMI supports separate funding – outside of the 811 program – for renewal of all expiring tenant-based subsidies (estimated to cost $32 million in FY 2003). Separate funding for these renewals is needed to avoid cuts to the Section 811 program and erosion of the program’s core mission of increasing the stock of decent, safe and affordable housing for people with more severe disabilities that need supports and services to live in the community.
NAMI supports continued funding for a separate allocation of tenant-based rental assistance for non-elderly people with disabilities adversely affected by the designation of public and assisted housing as "elderly only." (Congress has allocated over $250 million for this purpose since 1996).
NAMI supports increased funding for federal homeless-assistance programs and continued implementation of a minimum threshold for permanent housing programs for homeless adults with severe mental illness (e.g., Shelter Plus Care, SHP permanent housing). NAMI supports efforts in Congress to continue renewal of all expiring Shelter Plus Care and SHP permanent housing rent subsidies through the Housing Certificate Fund (HCF) as proposed in separate House and Senate bills (HR 3995 and S 2573).
NAMI supports legislation authorizing a new federal housing production program to serve households at 30 percent of median income and below (including HR 2349), with specific targeting of individuals for whom tenant-based rental vouchers have proven ineffective for securing stable housing.
NAMI opposes efforts to erode standards in the Fair Housing Act that protect group homes and other shared-living arrangements in the community from discriminatory zoning and land use policies.
Access to decent, safe, and affordable housing remains a tremendous challenge for adults with severe mental illnesses. Unfortunately, in virtually every part of the United States people with severe mental illnesses struggle to find good-quality housing they can afford. Many people with the most severe and disabling mental illnesses also need access to appropriate services and supports so that they can successfully live in community-based housing, which promotes their independence and dignity.
Unfortunately, the U.S. Department of Housing and Urban Development (HUD) and many state and local agencies responsible for administering our nation's affordable-housing system do little to alleviate this struggle to access community-based housing and supports. Historically HUD has made little effort to understand the real implications and bitter reality of recent federal housing policies, policies that have reduced the federally subsidized housing units available to people with severe mental illnesses and other disabilities.
Current housing policies were enacted by Congress in 1992 and 1996 to permit public and assisted-housing providers to designate housing as "elderly only." People with disabilities and their advocates understand that Congress must replace the hundreds of thousands of units of federally subsidized housing no longer available to people with disabilities, including people with severe mental illnesses. Unfortunately, HUD has also failed to preserve and adequately fund the Section 811 Supportive Housing for Persons with Disabilities program, which was designed to provide housing and supports to people with severe disabilities. But for the efforts of a few leaders in Congress, an increasing number of adults with severe mental illnesses would continue to live at home with aging parents or in substandard housing. Without additional resources, too many adults with severe mental illnesses will likely end up homeless or remain unnecessarily in inappropriate settings (e.g., homeless shelters and local jails and prisons).
The bitter irony of this loss of housing is that it comes when people with all types of disabilities (particularly severe mental illnesses) are increasingly able to live successfully in homes of their own—but only if independent housing is affordable and paired with appropriate supports and services. According to a 1999 HUD report, nearly 40 percent of the nation’s homeless are single adults with severe mental illnesses. In addition, an new report "Priced Out in 2000" reports that SSI income amounts to only 18.5 percent of median income nationally and that the average rent for a modest, one-bedroom apartment consumes, on average, 98 percent of a person's monthly SSI check.
These homeless and income numbers clearly demonstrate that people with disabilities (including severe mental illnesses) have the "worst" of the "worst case needs" and that their needs cannot be ignored by Congress, HUD, or state and local governments. While funding for tenant-based vouchers are helpful to many very low-income individuals with mental illnesses, new housing to serve people at the bottom of the economic ladder is also needed.
NAMI therefore supports efforts underway in Congress to establish a new, federal, flexible housing-production program for households at 30 percent of median income and below. In addition, proposals to restrict enforcement of the Fair Housing Act could make it more difficult to combat the "NIMBYism" that results from stigma and discrimination faced by group homes and other shared community-based housing.
Even though finding decent, safe, and affordable housing with adequate and appropriate support remains daunting for so many consumers and families, some progress has been made in recent years. Since 1997, NAMI worked closely with allies in Congress, including Rep. Rodney Frelinghuysen (R-NJ), to add more than $250 million to the HUD budget for tenant-based rental assistance for people with disabilities who have been (and will be) adversely affected by "elderly only" public and assisted housing designation. (Adults with severe mental illnesses are especially vulnerable in the "elderly only" housing designation process because of the stigma associated with their illnesses).
In 2001, Congress also maintained funding for homeless-assistance programs under the McKinney-Vento Act at $1.02 billion and continued separate funding for a $100 million account to ensure that all expiring rent subsidies under the Shelter Plus Care program are renewed in future years. Shelter Plus Care (part of the federal McKinney-Vento Homeless Assistance Act) is a critical resource for helping states and communities fund permanent housing and supportive services for homeless individuals with severe mental illnesses. This new account at HUD will ensure that formerly homeless tenants in Shelter Plus Care housing will not be at risk of losing their housing. In addition to the new account at HUD for Shelter Plus Care renewals, Congress continued for 2001 the requirement for a minimum 30 percent of funds to go toward developing permanent housing (and a 25 percent match requirement for communities using funds for services).
NAMI supports both a reliable, long-term source of funds for Shelter Plus Care and SHP permanent housing renewals and the 30-percent permanent housing set-aside, believing they are critical for ending homelessness instead of institutionalizing a homeless services system. NAMI supports HUD programs that finance permanent housing and public mental heath programs that fund supportive services to assist formerly homeless tenants in these settings. A 2001 University of Pennsylvania study demonstrates that permanent supportive housing for individuals with mental illness who are homeless are nearly as much as the costs of homelessness (emergency room treatment, psychiatric hospitalization, incarceration, etc.).
Finally, NAMI continues to work with allies in the disability community to oppose legislative proposals intended to scale back the existing protections in the Fair Housing Act that bar discriminatory zoning and the land-use policies that restrict placement of group homes and shared living arrangements in the community.
NAMI's Support for Federal Funding for Mental Illness
NAMI strongly supports efforts to substantially increase federal funding to ensure that there are adequate resources for promising biomedical research into brain disorders and genetics and supports initiatives focused on neural receptors, receptor subtypes, and modulators. NAMI applauds efforts in Congress and from the Bush Administration to increase funding for NIH, and urges that increases enacted in FY 2003 for the NIMH be directed to the most serious and disabling brain disorders. NAMI also supports changes in the NIMH mission that will place greater emphasis on the most serious brain disorders—including schizophrenia, major depression and bipolar disorder—in its research portfolio.
NAMI supports targeted increases in funding for programs at the Center for Mental Health Services (CMHS) at the Substance Abuse and Mental Health Services Administration (SAMHSA) that are focused on assisting states and communities in replicating evidence-based programs that serve children and adults living with severe mental illnesses.
National Institute of Mental Health (NIMH)
NAMI is extremely grateful to bipartisan leadership in Congress, and on the part of President Bush, to complete the goal of doubling the federal investment in biomedical research at the National Institutes of Health (NIH) by 2003. Completing this effort is a major achievement that you and your colleagues in Congress can truly can be proud of and that people with severe mental illness and their families are extremely grateful.
Thanks to important research funded by NIMH, through its current $1.118 billion budget, critical advances have been achieved in treatment for people living with serious brain disorders, such as schizophrenia and bipolar disorder, over the last decade. But we still have a long way to go. Medical science has yet to produce cures for severe mental illnesses. Furthermore, the most promising evidence-based treatments and services remain inaccessible for people who need and deserve them. From biomedical research to services research, NAMI believes that research on severe mental illnesses are under-funded. The proposed FY 2003 investment lacks equitable proportion to the scientific opportunities that exist and the tremendous burden of cost and pain that such disorders impose on NAMI families and the general public.
According to a recent study conducted by the World Health Organization, no less than four of the top ten causes of disability worldwide are severe mental illnesses. Major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder account for an estimated 20 percent of total disability resulting from all diseases and injuries. Based on NIH’s own estimates, for every research dollar spent, 15 cents is allocated to AIDS, 10 cents on cancer, two cents on heart disease, and less than one cent on schizophrenia and other severe mental illnesses. In contrast, the total costof schizophrenia to society, per research dollar spent, is $161.26, compared to only $65.65 for heart disease, $9.96 for cancer, and $6.86 for AIDS.
Clearly, more equitable, increased investment is needed for NIMH. Therefore while NAMI strongly applauds the increases proposed by the Bush Administration for NIH, NAMI also recognizes that the recommended increase for NIMH lags far behind the nearly 14% increase proposed for the other NIH institutes. NAMI therefore urges Congress to enact an equitable increase for NIMH relative to increases for the entire NIH as part of the FY 2003 Labor-HHS-Education Appropriations bill.
Center for Mental Health Services (CMHS)
The budget of the Center for Mental Health Services at SAMHSA contains a number of important programs that assist states and localities in increasing access to treatment and supports and improving the overall quality of services. NAMI urges Congress to support the following priorities as part of the FY 2003 Labor-HHS-Education Appropriations bill:
PATH – NAMI strongly supports the $7 million increase proposed by the President for the Projects to Assist Transition from Homelessness (PATH) program to help homeless individuals with severe mental illnesses and co-occurring substance abuse disorders. The Administration’s proposed increase for PATH would result in an additional 31,000 homeless individuals with severe mental illnesses receiving services. Given the disproportionate representation of adults with severe mental illness among the chronically homeless population, NAMI strongly supports the Administration’s efforts to place the highest priority in meeting their needs for permanent supportive housing and community-based services.
Mental Health Block Grant – The President’s budget proposes freezing the Mental Health Block Grant program at its FY 2002 level of $433 million. As a result of budget cuts at the state level, we are witnessing a continued widening of gaps in the public mental illness treatment system. The consequences of these emerging cracks in the service system are readily apparent, not just to our consumer and family membership, but also to the public: the growing number of homeless adults on our nation’s streets who receive no treatment services, well publicized tragic incidents involving individuals with severe mental illness who are not accessing adequate treatment services and the growing trend of "criminalization" of mental illness and the stress it is placing on state and local jails and prisons. NAMI supports an increase for the Mental Health Block grant program for FY 2003 and to target any additional funds for the program to replication of evidence-based service delivery models for persons with severe mental illness in the community. In particular, NAMI urges Congress to direct CMHS to target Block Grant funding to assertive community treatment (including the Program of Assertive Community Treatment, PACT).
Jail Diversion – The President’s budget requests $5 million for the CMHS Jail Diversion program for FY 2003. People with serious mental illness are frequently arrested for minor offenses, many times as a result of homelessness, and then they are incarcerated in jails where their mental health needs are not met. There are also significant numbers of persons with serious mental illness who come in contact with the police, but are not arrested. The U.S. Department of Justice estimates that 16% of all inmates in state and federal jails have a severe mental illness, as many as 283,000 people with serious mental illnesses were in jail or prison - more than four times the number in state mental hospitals. The CMHS Jail Diversion program assists states and communities in developing treatment programs to get non-violent offenders with mental illness out of the criminal justice system and into treatment. NAMI urges support for the Bush Administration’s request for the CMHS Jail Diversion program for FY 2003.
CMHS Discretionary Programs – The President’s budget proposes a $7 million reduction for the CMHS Projects of Regional and National Significance (PRNS) for FY 2003. Included in this proposal is a reduction for the Community Action Grants program. The Community Action Grants at CMHS are a critical link in federal efforts to support knowledge dissemination and replication of evidence-based practices, including integrated treatment, jail diversion, police training and cultural competence. There is growing concern that without guidance from Congress, CMHS will discontinue Community Action Grants in FY 2003. Communities have used these grants constructively to stimulate the development of good programs and services for people with severe mental illnesses. NAMI supports continuation of the Community Action Grants program in FY 2003.
New Project to Collect Data for Advocacy Asks: What is Necessary for Recovery?
The U.S. Surgeon General and the President's New Freedom Commission on Mental Health agree that now, more than ever, there are historic possibilities for consumer recovery. Yet, consumers are not fully benefiting from the increased chances for recovery. Both major national studies agree that for consumers to completely enjoy the possibility for recovery, we must understand the large gap that exists between what is possible for recovery, and the reality of the care environment across the country.
To investigate this gap and harness the possibilities for recovery, NAMI is launching TRIAD - Treatment/Recovery Information and Advocacy Database. TRIAD is a process by which NAMI, in collaboration with other stake-holders, will collect a variety of data that characterizes the gap between the services, supports, and environment we all agree are necessary for recovery and what exists in each state. But TRIAD will not just collect data - it also seeks to inform advocacy efforts with better data to achieve better investment and better services to ultimately close that gap.
In this process of data collection, TRIAD is organized around 12 standards of care that reflect the core services, supports and environmental requirements for a system to promote recovery among adults with serious mental illness. These standards of care directly reflect the Institute of Medicine's landmark study on reforming American healthcare-Crossing the Quality Chasm-when it calls for standards of safe, effective, timely and patient centered care that is equitably and efficiently delivered.
TRIAD Standards of Care
Access to Appropriate Medication
General Medical Care
Integrated Services for Dual Diagnosis
Family Psychoeducation and Support
Peer Provided Services and Supports
Supported Employment Services
Affordable Housing and Supports
Jail Diversion Programs
Non-stigmatizing and Non-discriminating Environment
Current TRIAD efforts include:
reports on the implementation of evidence-based treatments and outcomes for severe mental illnesses in adults;
a systematic assessment of discrimination in legislation and newspaper coverage of mental illness across the 50 states;
a national survey of consumer and family member experiences of evidence-based care and outcomes;
a consumer and family member oriented website with an interactive guide to evidence-based schizophrenia treatment.
To learn more about TRIAD or how you can help, please contact Abigail Graf at firstname.lastname@example.org.
Find Out More:
Institute of Medicine, National Academy of Sciences. (2001). Crossing the Quality Chasm.
Washington, DC. National Academy Press.
Interim Report of the President's New Freedom Commission on Mental Health. (2002).
U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon
General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
The 1999 Surgeon General’s report (Mental Health: A Report of the Surgeon General) revealed that fewer than one-third of all people with a diagnosable mental disorder in the U.S. receive treatment in a given year. And, the 1998 report from the Schizophrenia Patient Outcomes Research Team (PORT) study revealed that fewer than 50% of all people with schizophrenia receive even minimally adequate treatment in a given year. These treatment access problems are even worse for children and adolescents with severe mental disorders.
There are many factors contributing to low rates of treatment and services for people with mental illnesses across the country. One contributing factor is the lack of qualified psychiatrists and other mental health providers in many regions of the country, particularly in rural areas.
One solution proposed to address access to care barriers is to expand prescribing privileges to psychologists. In 2002, New Mexico became the first State to enact legislation expanding prescription privileges to certain psychologists. Emboldened by success in New Mexico, it is anticipated that psychologists will push similar legislation in other states with renewed vigor in 2003 and beyond. In fact, Task Forces to explore the feasibility of expanding prescription privileges to psychologists have been formed in 31 states.
There are many difficult questions that must be addressed as the debate on prescription privileges for psychologists ensures. These include:
What impact would expanding prescription privileges to psychologists have on the quality of care, safety and well-being of individuals with mental illnesses?
What amount of academic training, hands-on experience, and clinical supervision and oversight is necessary to adequately prepare psychologists to prescribe psychiatric medications?
What impact, if any, will expanding prescription privileges have on access to care and quality of care for individuals with mental illnesses residing in rural or under-served regions?
Should different standards apply to psychologists prescribing medications for the treatment of acute, temporary mental health conditions (e.g. situational depression) versus prescribing medications for the treatment of chronic, severe mental illnesses (which are often compounded by other complex medical conditions)?
Should psychologists authorized to prescribe medications be limited to prescribing certain medications on formulary or afforded unlimited authority to prescribe all psychiatric medications?
Are the experiences of other allied mental health professionals with limited prescribing authority in many states (such as physicians assistants and nurse practitioners) instructive in informing the debate on whether psychologists should prescribe?
What outcomes have been derived in current or previous experiences with psychologists prescribing medications (e.g. the Department of Defense Psychopharmacology Demonstration Project, the year old New Mexico law) that can help inform this debate?
Learn more about NAMI staff below. For more information or to get a high resolution photo please contact Alexis O'Brien, Media Relations Associate.
NAMI Legal Center
The NAMI Legal Center advocates on behalf of individuals with severe mental illnesses and their families. Our Legal Center works both independently and collaborates with private attorneys, legal service organizations, mental health and consumer advocacy organizations on projects of mutual interest.
Jail Diversion Strategies, including Police Crisis Intervention Training (CIT) teams & Mental Health Courts;
Access to treatment for inmates with serious mental illnesses;
Discharge planning & transitional services; and
Training of Law Enforcement & Court Personnel.
NAMI Law and Science Center - - The Center was created to provide technical assistance to lawyers suing third party public and private sector payers to promote unrestricted access to medications. The Center provides technical assistance on clinical, legal and health economics issues to lawyers representing people with mental illnesses or their families in pertinent cases, with a particular focus on linking lawyers with information, materials and experts needed to develop and advance their cases on access to medications and services.
Unfortunately the NAMI Legal Center is not able to provide individual representation in legal matters. However, we maintain two lawyer referral panels, a general referral panel and an elder and estate planning panel, and may be able to refer you to an attorney for representation. If you are interested in a lawyer referral, or in joining our panels, please click here.
Recovery is a process, beginning with diagnosis and eventually moving into successful management of your illness. Successful recovery involves learning about your illness and the treatments available, empowering yourself through the support of peers and family members, and finally moving to a point where you take action to manage your own illness by helping others.
Untreated Mental Illness: A Needless Human Tragedy
Severe mental illnesses are treatable disorders of the brain. Left untreated, however, they are among the most disabling and destructive illnesses known to humankind.
Millions of Americans struggling with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, know only too well the personal costs of these debilitating illnesses. Stigma, shame, discrimination, unemployment, homelessness, criminalization, social isolation, poverty, and premature death mark the lives of most individuals with the most severe and persistent mental illnesses.
Mental Illness Recovery: A Reality Within Our Grasp
The real tragedy of mental illness in this country is that we know how to put things right. We know how to give people back their lives, to give them back their self-respect, to help them become contributing members of our society. NAMI's In Our Own Voice, a live presentation by consumers, offers living proof that recovery from mental illness is an ongoing reality.
Science has greatly expanded our understanding and treatment of severe mental illnesses. Once forgotten in the back wards of mental institutions, individuals with brain disorders have a real chance at reclaiming full, productive lives, but only if they have access to the treatments, services, and programs so vital to recovery.
Newer classes of medications can better treat individuals with severe mental illnesses and with far fewer side effects. Eighty percent of those suffering from bipolar disorder and 65 percent of those with major depression respond quickly to treatment; additionally, 60 percent of those with schizophrenia can be relieved of acute symptoms with proper medication.
Assertive community treatment, a proven model treatment program that provides round-the-clock support to individuals with the most severe and persistent mental illnesses, significantly reduces hospitalizations, incarceration, homelessness, and increases employment, decent housing and quality of life.
The involvement of consumers and family members in all aspects of planning, organizing, financing, and implementing service-delivery systems results in more responsiveness and accountability, and far fewer grievances.
Speak out on the policy issues that affect people with mental illnesses.
What You Need to Know About Insurance Parity
Share Your Story
Share your personal experiences with parity implementation. What positive experiences have you had? Are you having a negative experience with the new law? NAMI needs to hear from you.
This information is critical to informing policymakers in the U.S. Congress and the Obama Administration on additional steps that may need to be taken to strengthen the law and ensure adequate enforcement. In addition, it is critical for NAMI to demonstrate to the larger public that parity is making a real difference in improving coverage of mental illness treatment and expanding access to critical medical services for children and adults living with mental illness.
Visit this site for email and phone contact information and resources that answer the following questions:
what the federal law covers;
how a state's law works with the federal parity act
where to file a complaint;
what's involved in filing an insurance claim with your health plan when benefits have been denied;
when an external review is warranted and
what it means to file an ERISA claim.
Fight Stigma: Become A StigmaBuster!
What is NAMI StigmaBusters?
NAMI StigmaBusters is a network of dedicated advocates across the country and around the world who seek to fight inaccurate and hurtful representations of mental illness.
Whether these images are found in TV, film, print, or other media, StigmaBusters speak out and challenge stereotypes. They seek to educate society about the reality of mental illness and the courageous struggles faced by consumers and families every day. StigmaBusters' goal is to break down the barriers of ignorance, prejudice, or unfair discrimination by promoting education, understanding, and respect.
Each month, close to 20,000 advocates receive a NAMI StigmaBusters Alert, and it is read by countless others around the world online. Send it to your own personal and professional networks.
Recent legislation has helped more veterans and their families access the mental health care and other services they need. More action will be needed on behalf of the nation's veterans of today and tomorrow.
Posttraumatic Stress Disorder (PTSD) is an anxiety disorder than can develop after a person witnesses a traumatic event. A traumatic event can take many forms--a natural disaster, sexual abuse or a terrorist attack such as 9/11--but for veterans, PTSD is most often related to combat or military exposure.
In wars prior to Vietnam, the disorder was referred to as “shell shock” or “battle fatigue” and was not very well understood beyond the fact that it limited the soldier’s performance on the battlefield. Today, the disorder is more widely studied. We know that PTSD can lead to other mental health problems such as depression, social withdrawal and substance abuse.
Our PTSD section for veterans includes resources where you can find out more about PTSD, learn about treatments and read about how PTSD affects families and children of veterans.
More than 100,000 combat veterans sought help for mental illness since the start of the war in Afghanistan in 2001, and about one in seven of those have left active duty since then, according to VA records collected through 2007. Almost one-half of those were PTSD cases.
Mental health cases among war veterans, including PTSD, drug and alcohol dependency and depression, grew by 58 percent from 63,767 in 2006 to 100,580 in 2007, VA records show.
A study released in 2007 stated that of 103,788 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans seen at VA health care facilities, 25,658 (25 percent) received mental health diagnoses; 56 percent of whom had two or more distinct mental health diagnoses.
Overall, 32,010 (31 percent) of veterans in the same study received mental health and/or psychosocial diagnoses. The youngest group of OEF/OIF veterans (aged 18-24 years) were at greatest risk for receiving mental health or posttraumatic stress disorder diagnoses compared with veterans 40 years or older.
In 2003, an estimated 56.6 percent of veterans used alcohol in the past month compared with 50.8 percent of comparable nonveterans. An estimated 13.2 percent of veterans reported driving while under the influence of alcohol or illicit drugs in the past year compared with 12.2 percent of comparable nonveterans. Daily cigarette use was more common among veterans, with an estimated 18.8 percent smoking cigarettes daily in the past month compared with 14.3 percent of comparable nonveterans.
In 2002/2003, an estimated 1.2 million male veterans were identified as living with serious mental illness. Approximately 340,000 of these individuals had co-occurring substance abuse disorders. Approximately 209,000 female veterans (13.1 percent) reported serious mental illness, and 25,000 (1.6 percent) reported co-occurring substance use disorder with mental illness.
Army Veteran Jennifer Crane discusses her recovery from
For example, the Department of Veterans Affairs offers a Center for Women Veterans on its website and the VA Palo Alto Health Care System introduced the Women’s Health Care Center in 2002. Designed to be sensitive to women’s concerns, it offers individual and group therapy, with psychoeducational classes and seminars tailored to the unique needs of women veterans. The Women Veterans Health program was elevated to a Strategic Health Care Group within the Office of Public Health and Environmental Hazards in 2007.
As part of the National Center for PTSD in Menlo Park, Calif., the Department of Veterans Affairs also introduced the National Women’s Trauma Recovery Program to treat women veterans living with PTSD or Military Sexual Trauma (MST). According to the National Center for PTSD, women in the military run a double risk of developing PTSD—10 percent of women versus 4 percent of male service members—for reasons ranging from battle stress and sexual harassment to assault. The VA also says that women may take longer to recover from PTSD and are four times more likely than men to experience long-lasting PTSD.
For women veterans we have included information on gender-specific PTSD treatment as well as VA services and links to organizations serving women veterans.
Sesame Street Family Connections offers videos and
resources to help kids understand a variety of life-changing
events like a family member's deployment and return.
Some families don’t reunite. The Army’s Medical Health Advisory Team surveyed married junior enlisted officers in 2008 and found that after 15 months of deployment, almost 30 percent were planning divorce or separation. According to data compiled by the Associated Press, divorce rates in the Marine Corps and Army have increased. There are fewer recent statistics about divorce rates after leaving active duty, but the National Center for PTSD cites studies of Vietnam Veterans which found that rates of divorce were much higher than among the general population. This may be related to PTSD and associated problems with intimacy or caregiver stresses.
If a veteran has returned with a disability, the family’s finances may be affected while caregivers’ responsibilities are further stretched by the complicated claim system. Yet with help, many veterans can access VA-backed loans, educational benefits, employment assistance and even educational benefits for dependents that can help get their families back on track.
Army Long-term Family Case Management
This call center and website offer long-term assistance to those who have lost a loved one who was a service member. They provide information about Social Security, VA and death benefits as well as lists of local programs for children and other kinds of support.
Coming Home Project
This nonprofit organization is dedicated
to providing compassionate expert care, support, education and stress management tools for Iraq and Afghanistan veterans, service members and their families.
Gold Star Wives
Gold Star Wives is a nonprofit membership organization for people who have lost spouses in the military. They offer local chapters, memorial programs, support and benefit information.
Society of Military Widows
The Society of Military Widows is a nonprofit membership advocacy and support organization. They provide information about benefits, supports and networking via local chapters.
Comfort Zone Camp Comfort Zone Camp provides grief support weekend camps for children ages 7 to17 and offers special programs for children in military families.
TAPS (Tragedy Assistance Program for Survivors)
TAPS offers support for survivors: peer support as well as 24-hour crisis intervention. They also provide information about benefits and other services, survivor seminars, camps for children and online chat.
General Sources for Support
The American Legion
The American Legion is a national community service organization with leadership and community programs across all 50 states, the District of Columbia, Puerto Rico, Mexico, France and the Philippines.
AMVETS provides information, counseling and claims service to all honorably discharged veterans and their families concerning benefits. They are also involved in community service and advocacy.
Disabled American Veterans (DAV)
This organization is led by disabled veterans who are focused on building better lives for disabled veterans and their families.
Research is vital to advancing our understanding of mental illness and, eventually, finding a cure. Research is the ultimate source of hope for people living with mental illness and their families. And research is imperative if we are to understand early intervention strategies as well as all we can about the mental illness continuum including medication side-effects, nutrition, recovery and more.
In addition to the information resources below, NAMI frequently features research content in the Advocate, NAMI’s membership magazine. Join today to start receiving the Advocate. If you're already a member, visit the Advocate online.
Welcome to the NAMICITCenter. Our mission is to provide NAMI members, local law enforcement and mental health providers with assistance and up-to-date information about Crisis Intervention Team (CIT) programs. The NAMICITCenterserves as a clearinghouse of information about CIT programs nationwide. The Center facilitates ongoing communications between CIT programs and engages in national networking to establish standards and promote the expansion of CIT.
For more information, or to sign up for our mailing list, email Laura Usher at email@example.com.To subscribe on our e-newsletter, CIT in Action, go to www.nami.org/subscribe and follow the instructions to subscribe to a newsletter. Click on the links below to read past issues of CIT in Action.
NAMI is pleased to be working with the College of Psychiatric and Neurological Pharmacists to offer a new section where Psychiatric Pharmacists write and answer questions that they experience in the course of their work with individuals with mental illness. We will periodically be posting new questions and answers so be sure to check back frequently.
What Does It Mean To Be A Neuropsychiatric Pharmacist?
Watch this powerful video on what it means to be a neuropsychiatric pharmacist from the 2010 CPNP Video Contest.
This video about veterans living with a traumatic brain disorder is part one of three in the In Their Boots documentary series.
A brain injury is a long-term or temporary disruption in brain function resulting from injury to the brain. Traumatic Brain Injury (TBI) occurs when there is a strong enough impact to the head to cause damage to the brain. Common causes of TBI include motorcycle accidents, sports injuries, falls or acts of violence.
TBI has been called the “signature injury” of the current conflicts in Iraq and Afghanistan. Increasingly, soldiers are surviving nearby bomb blasts, which produce brain injury through pressure waves that “shake” the brain, which can cause symptoms ranging from dizziness and drowsiness to vomiting, severe headache and shock. If the injury is severe enough the damage can be irreversible, leaving lasting mental effects including depression, anxiety, personality changes, aggression, acting out and social inappropriateness. TBI can cause changes in personality, thinking and sensation and increase the risk of conditions such as Parkinson’s disease, Alzheimer’s disease and other brain disorders.
In soldiers, the symptoms may also overlap with Posttraumatic Stress Disorder (PTSD), making it more difficult for doctors to treat.
Veterans affected by TBI and their families often need help navigating the system and support that takes into account the special needs of veterans. The good news is that there are many others who have been touched by a TBI and are trying to help others. See this Washington Post Q & A with Cheryl Lynch, mother of someone living with a traumatic brain injury and founder of American Veterans with Brain Injuries.
NAMI created the Multicultural Action Center in 2002 to focus attention on system reform to eliminate disparities in mental health care for diverse communities, ensure access to culturally competent services and treatment for all Americans and particularly to help and support people of diverse backgrounds who are affected by serious mental illness.
High expectations, loneliness and stress can lead to the Holiday Blues during the season from Thanksgiving to New Year’s. In most cases, symptoms are temporary, but they can be serious if they last for more than 2 weeks, leading to clinical anxiety and/or depression. People already living with mental illness often find that their conditions worsen during the holidays.
NAMI's Medical Director, Ken Duckworth, M.D., is available to talk about the holiday blues on your radio or TV show.
NAMI offers information to health and lifestyle editors, producers and reporters and others working on stories about the holiday blues. They include tips on avoiding or minimizing the blues, as well as related topics.
Welcome to the NAMI Newsroom, the place for reporters, advocates and other media professionals. NAMI's communications services team is available around-the-clock to news media for:
Expert analysis on a wide range of issues related to severe mental illnesses or brain disorders such as schizophrenia, bipolar disorder/manic-depression, major depression, and anxiety disorders.
Current data on research, treatments, rates of prevalence
Interviews with national spokespersons and technical experts
Access to persons with serious mental illness and their families who are willing to share personal stories with the media
Comment on breaking news
Bob Carolla, Director of Media Relations
3803 North Fairfax Drive
Arlington, VA 22203
Telephone: (703) 524-7600
Fax: (703) 516-7238
Examining our Mental Health System
Recent news and other national tragedies have resulted in important examinations of our nation’s mental health system. Along with working with our nation's leaders and holding discussions about how to improve mental health care it is important to look at all of the underlying causes that lead to these events and look at how we can prevent them in the future as well as providing resources and care for all of those affected.
This guide includes resources for policymakers, news media and the general public with information about NAMI policy, mental illness, outreach initiatives and resources for families. ... Read More.
For NAMI Press Releases, you may read the most recent release below, or visit the Press Release Archive to browse releases from 1997 - present.