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 you can download a copy from
the Surgeon General’s web site at
www.surgeongeneral.gov.
For more information about NAMI’s activities on the overall
strategy of the report, please call Clarke Ross at 703/312-7894. For
more information on this report as it applies to children, please
call Brenda Souto at 703-516-7987. All media representatives, please
call NAMI’s communications staff at 703/516-7963.
For information on serious
mental illnesses and brain disorders, or for a referral to
your State
and local affiliates, please contact the NAMI HelpLine:
1-800-950-NAMI (6264) / TDD 703-516-7227 Visit the HelpLine
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