A Report on America’s Health Care System for Adults with Serious Mental Illness
Grading the States 2009: A Report on America’s Health Care Sytem for Adults with Serious Mental Illness
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NAMI's Recommendations for States and the Federal Government

4. Promote Recovery and Respect

Where We're Failing

People with mental illnesses are often dismissed as being incapable of making informed decisions or of shaping the course of their lives. NAMI’s survey of states and consumers reveals the many ways in which this manifests itself:

  • Many consumers are treated disrespectfully, or even abusively, by those charged with helping them
  • Provider education is a low priority
  • Peer-based services and supports are under-utilizedand under-supported
  • Vital life services, such as housing and employment support, are scarce and unnecessarily tenuous
  • Mental health services frequently do not take into account a person's cultural or language background

Taking Action

Employ Peer Specialists

  • Peer counselors and peer specialists should be an integral part of public mental health care service delivery systems. A number of states have taken positive steps in this regard by establishing educational and certification programs for peer specialists. Some states also reimburse certified peer specialists through their Medicaid programs. All states should adopt and expand these promising practices.

Fund Peer-Run Services

  • Increasingly, states are funding consumer-run programs that provide services such as telephone warm lines, drop-in centers, and public education on mental illness and recovery.

Fund Peer Education Programs

  • Many states fund peer education programs such as the Wellness-Recovery-Action-Plan (WRAP) program and Peer-to-Peer.

Provide Culturally and Linguistically Competent Services

  • There are currently broad variations in the commitment of states to providing culturally and linguistically competent services. All states should make it a priority to improve in these areas. For example, states should move beyond the development of cultural competence plans to actual statewide implementation, including documenting progress and clear outcomes.

Invest Resources in Reducing Human Rights Violations

  • A number of states have taken positive steps to reduce or eliminate the inappropriate use of seclusion and restraints in their psychiatric treatment facilities. For example, Pennsylvania, through a combination of standard setting and staff education, has reduced the use of seclusion and restraints by 99 percent in its inpatient psychiatric treatment facilities.
  • Two federal agencies, the U.S. Department of Justice and the U.S. Department of Health and Human Services, play important roles in enforcing civil rights protections for people with mental illnesses in institutional settings such as hospitals, nursing homes, and correctional facilities. Additional funding should be provided to enable these agencies to carry out these important functions.

Increase Employment Opportunities

  • Supported employment is an evidence-based practice with proven effectiveness in helping consumers attain competitive employment and thereby enhance their recovery. Unfortunately, supported employment and other meaningful employment opportunities are not available in many parts of the country. All state mental health agencies should enter into agreements with their vocational rehabilitation counterparts to collaborate on expanding supported employment and other employment opportunities for people with serious mental illnesses.

Increase Housing Opportunities

  • Independent, affordable housing, with supports available, is a critical component of recovery. While the NAMI survey revealed a few examples of strong collaborative efforts between mental health and housing agencies, coordination and collaboration is too often lacking. State mental health agencies must become more involved with their state housing agencies to create a variety of community housing options.

Continue to recommendation 5: Increase services for people with serious mental illnesses who are at greatest risk  >>

"I prefer to use the terms 'manage' and 'coping' rather than recovery. (It's like) my struggle with heart disease. Given the limits of modern medicine, I'll never recover from my damaged heart, but I've learned to manage the symptoms."
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Mike Fitzpatrick, NAMI Executive Director

Consumer and Family Member Comments
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