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Ron Manderscheid, PhD, Executive Director, of NACBHDD writes about "Implementing Service Improvements for Adults with Serious Mental Illness"

On November 12 and 13, I served as convener and host for a major national meeting in Washington, D.C., designed to identify, build consensus, and prioritize needed improvements in services for adults with serious mental illness. The meeting, "National Action Meeting on Fostering System Reform for Adults with Serious Mental Illness", was convened because National Health Reform will provide a unique opportunity to implement these needed improvements. To my knowledge, no similar meeting has ever been convened in the past with this focused objective.

Adults with serious mental illness comprise almost 6 percent of the U.S. population. All have illnesses that can lead to problems in one's life in the family, workplace, and community. It is well-known that services for this population have major deficits that can be corrected. However, clear definition of key solutions is frequently absent, as is the political will to implement these solutions. Our meeting was intended to confront these issues head on and move the agenda forward.

In preparation for the meeting, six short background papers were each prepared by two authors, one from a national organization and the other from an academic setting. These papers and their authors were: access to care (David Shern, Mental Health America, and Michael Blank, University of Pennsylvania); continuity of care and adherence (Bill Emmet, Campaign for Mental Health Reform, and Mona Martin, Health Research Associates), mental health insurance, coverage, and reform (Michael Fitzpatrick, National Alliance on Mental Illness, and Barry Brauth, private consultant); personalized mental health care (Linda Rosenberg, National Council on Community Behavioral Healthcare, and Neal Adams, (Optum Behavioral Healthcare); recovery and wellbeing (Dan Fisher, National Coalition of Consumer/Survivor Organizations, and Anita Everett, Johns Hopkins University); and total health care (Thom Bornemann, Carter Center Mental Health Program), and Ben Druss, Emory University).

More than 65 participants were invited to participate in the meeting. These leaders reflected the full range of stakeholders concerned with services for this population. Stakeholders included consumers and family members, service innovators, public system managers, researchers, payers, and key representatives of national organizations. The meeting was led by Joe Parks, Missouri Department of Mental Health, and Arthur Evans, Philadelphia Department of Behavioral Health and Mental Retardation.

At the outset, Neera Tanden, Senior Advisor from the HHS Office of National Health Reform, presented a detailed update on the status of reform efforts, as well as an assessment of prospects over the next 6 months. This energizing presentation was followed by short summaries of the recommendations contained in the six background papers. Richard Frank, Deputy Assistant Secretary of Planning and Evaluation at HHS, offered comments that provided insight into the likely future of the mental health field.

At the core of the meeting, participants were then subdivided into six work groups, each of which reflected one of the sets of recommendations. Each group debated what the precise recommendations should be from that group. Touchstone, a subsidiary of SRA International, led the discussion and the process so that each group was able to identify and reach consensus on three key recommendations.

All participants then voted on the final 18 recommendations, and the top five were selected for focused post-meeting advocacy. These five recommendations are:

    ➢Design and implement a robust set of performance measures, including consumer outcomes.

    ➢Commit to seeing people with serious mental illness have the same lifespan as the general population.

    ➢The Federal Government should require and provide incentives for a shared information health record that includes behavioral health.

    ➢Insist that federally sponsored primary care medical homes include behavioral, substance use, and mental health care.

    ➢The Federal Government should define medical necessity to align with research on the range of services required by persons with serious mental illness.

A short document has been prepared for the advocacy phase of this endeavor, which will detail specific steps necessary to implement these recommendations. The advocacy phase will take place beginning now.

Funds to undertake this very important work were provided by Janssen Pharmaceuticals. Under recently passed federal law, Janssen was not permitted to have input on the meeting agenda, selection of meeting participants, the background papers, or the conclusions reached. On behalf of the field, I want to thank Janssen for making these resources available for such a notable endeavor.

Great energy and enthusiasm were expressed by participants during the course of the meeting. Now we need to translate that enthusiasm and energy into focused advocacy for these badly needed reforms.

The action report, Fostering System Reform, can be downloaded here (pdf).

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