As Charles Dickens wrote, "it was the best of times, it was the worst of times." This is an apt description for public mental health services in the United States today. While we have seen significant advances in the development and use of proven treatments for people with serious mental illnesses, the very existence of these treatments perpetrates a cruel irony on the many consumers (and families) who do not have access to them.
This report documents significant shortages of evidence-based and promising practices in virtually every state in the country. In some places, desperately needed services are not available at all.
With proper treatment, services, and supports, the lives of people living with serious mental illnesses can be substantially improved; recovery is indeed possible. Grading the States 2009 follows in the footsteps of the New Freedom Commission, the National Academy of Sciences' Institute of Medicine, and the U.S. Surgeon General in identifying a specific set of actions to achieve success. And yet, as a nation, we are not taking these steps. Year after year, we continue to fail to support many of the most vulnerable among us.
The costs of our failure to provide adequate services to people with serious mental illnesses are also well known: disproportionate dependence on public income supports and medical benefits; over-reliance on costly treatments in emergency rooms; high rates of incarceration in America's jails and prisons; and low rates of employment.
To address these concerns, and put our nation's public mental health system on the path to maximum efficiency and effectiveness, NAMI recommends that states and the federal government undertake these five actions:
The following discussion briefly reviews the context for each of these recommendations and then identifies specific action steps in each area. Where possible, noteworthy state efforts are highlighted to encourage replication of promising practices.
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