NAMI APPLAUDS PRESIDENT BUSH’S “NEW FREEDOM INITIATIVE”
Today the President committed to sign a series of Executive Orders directing agencies across the federal government to take actions to move toward the goals in the overall package.
The President's orders are consistent with his "New Freedom" speech on the rights of people with disabilities, delivered in Portland, Maine on June 15, 2000. They build on the foundations of the landmark 1999 Surgeon General's Report on Mental Health and offer hope for change in a mental healthcare system that is grossly inadequate.
NAMI welcomes the appointment of a National Commission on Mental Illness Treatment Services to study and make recommendations for improvement in the availability and delivery of services, including new technologies. NAMI strongly urges that the National Commission adopt the approach and priorities of a similar commission proposal contained in S..2639, legislation introduced last year by Senators Pete Domenici (R-NM) and Edward Kennedy (D-MA).
Intended to promote early intervention and scientific, evidence-based treatment for children and adults with severe mental illnesses, several provisions of S.2639 already have been enacted. The President now has a significant opportunity to build on the tradition of bipartisan cooperation in Congress on mental illness issues, by adopting the framework of S.2639's provisions.
NAMI also welcomes the President's executive orders to implement fully the Ticket to Work and Work Incentives Improvement Act (TWIIA) enacted in 1999, and to help states move to comply with the U.S. Supreme Court's Olmstead decision that same year.
Together, they offer hope of greater independence and community integration for people with psychiatric disabilities. The President has committed his administration to supporting the removal of unfair barriers to people with serious mental illnesses living and working in local communities.
The President's actions offer hope for change in our mental healthcare systems, hope for effective treatment, hope for recoveries, and hope for the future for millions of Americans.
More detailed information on President Bush's "New Freedom Initiative" is included below.
At a White House ceremony today, President Bush released a series of policy initiatives designed to assist people with disabilities, including children and adults with severe mental illnesses, in achieving greater independence and community integration. The President's "New Freedom Initiative" was originally proposed during last year's election campaign. Today the President signed a series of Executive Orders directing agencies across the federal government to take actions to move toward the goals in the overall package. These Presidential orders apply only to the executive branch and thus do not require congressional action.
The "New Freedom Initiative" contains over a dozen separate goals all designed to improve educational, employment, housing and community support opportunities for people with disabilities. Among the highlights are a pledge that the new Administration will fully enforce the Americans With Disabilities Act (ADA). The proposal also reiterates the President's plan to seek full funding of the federal commitment special education under the Individuals With Disabilities Education Act (IDEA) and seek increased investment in assistive technology. The full text of the White House announcement can be viewed at http://www.whitehouse.gov/news/
Of particular concern to NAMI are the establishment of a new national commission on mental illness treatment services, a pledge to fully implement the Ticket to Work and Work Incentives Improvement Act (TWWIIA) and a plan to assist states in complying with the Supreme Court's Olmstead decision.
1) National Commission on Mental Illness Treatment Services
The Executive Order the President committed to sign today will establish a National Commission on Mental Health Services. The Commission will "study and make recommendations for improving America's mental health service delivery system, including making recommendations on the availability and delivery of new treatments and technologies for individuals with severe mental illness."
NAMI strongly endorses this action by President Bush. Although other parts of the Executive Order refer primarily to coordination among Federal agencies, there is a profound need for this broader examination of the mental health services system. Public services to treat mental illness are largely a function of state and local governments; however, current Federal policies heavily influence these state and local programs. Any commission examining mental health services should study the entire system of funding and service delivery.
The details of the commission's membership and charge have not yet been specified. NAMI recommends that the commission be modeled on last year's bipartisan proposal put forward by Senators Pete Domenici (R-NM) and Edward M. Kennedy (D-MA). NAMI was involved in the formulation of this proposal, contained in the Mental Health Early Intervention, Treatment and Prevention Act (S 2639), that would have authorized a commission to examine diagnosis, treatment, rehabilitation and hospitalization of individuals with mental illness and make recommendations on model state legislation based on their findings. The scope of the commission envisioned in S 2639 also included a) a review of the 1999 Surgeon General's Report on Mental Health, b) examination of the interaction between mental illness and criminal justice, c) a review of the effectiveness and results of state laws governing outpatient and inpatient involuntary treatment, and d) a study the use of psychiatric advance directives (on these two latter issues, the commission was to be charged with making recommendations for model state legislation).
The commission proposed by Senators Domenici and Kennedy also required representation from specific federal agencies (NIMH, CMHS), state and local officials (state mental health commissioner, judge, prosecutor, etc.), and stakeholders (consumer, family member, professionals, etc.). Thus, President Bush has a unique opportunity to follow through on the bipartisan groundwork established in Congress last year.
In January 2000, NAMI reviewed an analysis of mental health systems reform prepared for the Bush Campaign. Policy recommendations from this document have been included in the President's New Freedom Initiative and in the objectives of the new commission. To access this document, click on http://www.nami.org/update/mhreform.html
2) TWWIIA Implementation
In 1999, Congress enacted important legislation designed to address the complex and unfair disincentives against employment in Social Security's income support and health programs (SSI, SSDI, Medicaid and Medicare). Because the Ticket to Work and Work Incentives Improvement Act (TWWIIA) stretches across several of the federal government's most complicated programs and most cumbersome agencies, implementation has been far from simple. For example, the provisions governing extended Medicaid coverage for SSI beneficiaries seeking to enter the workforce depend on state adoption of new buy-in programs. Further, an examination of the proposed rules for Social Security's "ticket" program finds that there are numerous barriers preventing individuals with mental illness from using the program. All of these difficult implementation issues have been left for the new Bush Administration to grapple with. NAMI's most recent alert on implementation of TWWIIA can be found at http://www.nami.org/update/001228.html
Today, President Bush committed to sign an Executive Order that directs all the federal agencies involved (including Social Security and HCFA) to swiftly implement TWWIIA. NAMI strongly supports this action and urges that the new Administration pay specific attention to the flaws in Social Security's proposed "ticket" regulations to ensure that adults with severe mental illness are fully able to use the new program. NAMI also urges the Bush Administration to push for participation by the states in TWWIIA's Medicaid buy-in programs.
3) State Implementation of the Olmstead Decision
In June 1999, the U.S. Supreme Court handed down a landmark ruling (Olmstead v. L.C.) stating that the ADA obligates states to provide community placement for individuals with severe disabilities wherever possible. States are now in the process developing plans to bring their public mental illness and mental retardation systems into compliance with the decision. The Executive Order committed to be signed by the President today states the Administration's support community integration and the removal of barriers to community placement. To promote state compliance with Olmstead, the Executive Order directs federal agencies (including NIMH and SAMHSA) to coordinate research and pilot programs to make public mental health agencies more accountable through outcome measures.. NAMI strongly supports this initiative, particularly its focus on accountability for public mental health agencies. In NAMI's view, this goal is best achieved through replication of evidence-based, recovery-oriented service delivery models such as the Program of Assertive Community Treatment (PACT).
4) Homeownership Initiative
President Bush's "New Freedom Initiative" contains a proposal to allow Public Housing Authorities (PHAs) to offer people with disabilities receiving Section 8 tenant-based rental assistance a homeownership option. This option would allow disabled recipients of Section 8 to use up to a year's worth of their voucher in a lump sum payment to finance the downpayment or closing cost on a home. A nearly identical proposal was enacted by Congress as part of a housing authorization bill that was signed into law in December 2000.
While NAMI supports efforts to increase homeownership among people with disabilities, questions remain as to whether this is a viable option for non-elderly adults with severe disabilities. On average, monthly SSI benefits are less than 20% of area median income - far below any reasonable standard for homeownership in nearly every housing market. Several homeownership pilot programs for people with disabilities developed in recent years have proven ineffective in reaching households below 30% of median income, let alone down to the incomes of SSI beneficiaries.
Instead of focusing limited federal housing resources on homeownership, NAMI has been urging HUD to place greater emphasis on rental housing and support services as the answer for assisting non-elderly adults with severe disabilities to achieve greater independence and community integration. Specifically, NAMI has been supporting more funding for the HUD Section 811 program, additional Section 8 vouchers for people with disabilities, a new rental housing production at HUD that focuses on supportive housing, and preservation of existing stock of affordable rental housing.
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