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A Vision for Transforming State Public Mental Health Systems

In 2003, the presidential New Freedom Commission described mental health care in the United States as a "system in shambles," in need of fundamental transformation. Three years later, in another major report, the National Academy of Sciences' Institute of Medicine (IOM) proposed a major overhaul of our behavioral health care system, calling it "untimely, inefficient, inequitable, and at times unsafe." These findings built on the U.S. Surgeon General's landmark 1999 Report on Mental Health. Yet despite these repeated calls for reform, the prospects for people with serious mental illnesses in this country remain bleak.

The nation can sit idly no longer. It is time to break down the barriers in government that have led to the abandonment of people with serious mental illness; and to undo years of bad policies that have increased the burdens on emergency rooms, the criminal justice system, families, and others who have been left to respond to people in crisis. We must invest adequate resources in mental health services that work and finally end the pervasive fragmentation in America’s system of care.

A transformed mental health system would be comprehensive, built on solid scientific evidence, focused on wellness and recovery, and centered around people living with mental illnesses and their families. It would be inclusive, reaching underserved areas and neglected communities, and fully integrated into the nation’s broader health care system.

A transformed system will require new attitudes and new investment. To reach this goal, we need vision and political will-on Capitol Hill, in state legislatures, and in communities across America. The good news: we know now what is necessary to create the mental health care system we want to see. Building on NAMI's 2006 Grading the States report, this 2009 edition identifies the pillars of a high-quality system, provides an unvarnished assessment of where we are—state-by-state and as a nation- and identifies specific recommendations to guide the field towards the vision.

10 Pillars of a High-Quality State Mental Health System

As a nation, and as a mental health community, our knowledge base about mental illness is uneven. We know far less than we should about the causes and courses of mental illnesses. On the other hand, we know a lot about the staggering consequences-for the individual, for families, and for society-of untreated mental illness. We know that we provide treatments and services too late, and that too few people get the help they need to experience recovery. We also know that in order to deliver effective treatments to the many people who need them, public mental health service systems need to change dramatically.

Based on what we know, derived from 30 years of research and work in the field, NAMI understands what a successful mental health system must include. NAMI believes deeply that a transformed mental health system has the following very specific characteristics. It is:

  1. Comprehensive;
  2. Integrated;
  3. Adequately funded;
  4. Focused on wellness and recovery;
  5. Safe and respectful;
  6. Accessible;
  7. Culturally competent;
  8. Consumer-centered and consumer- and familydriven;
  9. Well-staffed and trained; and
  10. Transparent and accountable.

These are the 10 pillars of a high-quality mental health system.

Detailed Information (PDF)

"Recovery is a team effort…It takes 'a village' as they say to assist an individual in recovery. A psychiatrist and medications alone are not the answer."

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