2. Priority and Special Population

2.1 Priority Population

NAMI identifies as the priority population those persons of all ages who have severe and persistent mental illnesses, including: (Revised March 2006) schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and other severe anxiety disorders, borderline personality disorder, post traumatic stress disorder (PTSD), autism and pervasive developmental disorders, and attention deficit/hyperactivity disorder. These disorders represent the major mental disorders that current scientific data and consensus conclude are identifiable, disabling medical illnesses, with significant biological underpinnings, and requiring treatment. (Revised March 2006)

And

Other severe and persistent mental illnesses that affect the brain:
with seriously disabling consequences or a high risk of mortality; and
that have a long term course.

2.2 Additional Support

NAMI believes that individuals with these serious mental illnesses often require additional support to have their specific needs met and to ensure their access to integrated systems of care, education, and rehabilitation.

2.3 Cultural Diversity

(2.3.1)     Persons of cultural, racial, religious, and ethnic diversity and those for whom English is not the primary language have unique characteristics that sometimes impede their abilities to benefit fully from existing treatment, training, and rehabilitation programs. These differences must be respected and accorded appropriate representation, both within the governance of the services sector and within NAMI.

(2.3.2)     NAMI supports expanded efforts toward recruitment and training of professionals from these groups, the development and distribution of materials in appropriate languages for use in education, encouragement of their participation in programs and services, and outreach efforts targeted to these grossly underserved groups.

(2.3.3)     NAMI urges the incorporation of ethnic and cultural perspectives and competence into the design and implementation of programs and procedures for persons with serious mental illnesses so that diagnostic evaluations, consumer and family communications, and the provision of treatment and services will be free from bias and cultural impediments.

(2.3.4)     NAMI believes that providers must have training and sensitivity to cultural diversity.

(2.3.5)     NAMI deplores the higher rates among minorities of involuntary commitment and incarceration in penal facilities that occurs among minorities with serious mental illnesses versus non-minorities with similar diagnoses.

2.4 Adults Who Are Elderly

NAMI calls for the development of suitable, non-discriminatory community residences and the same improved services for elderly persons with serious mental illnesses as for other adults.

2.5 Adults Who Are Veterans

(2.5.1) NAMI believes that veterans should receive the same full range of integrated services within the hospital and upon discharge to the community that are received by other people with serious mental illnesses.

(2.5.2) NAMI calls for veteran’s hospitals and veteran’s outpatient treatment programs to be held to the same standards of performance as all other hospitals and outpatient treatment programs.

2.6 Persons Who Are Homeless and/or Missing

(2.6.1)     NAMI advocates for the right to treatment for persons with serious mental illnesses who are homeless and for those at risk of becoming homeless. These citizens have the same needs and rights to shelter and treatment as all other persons with serious mental illnesses. NAMI believes that persons with serious mental illnesses who are homeless should have individualized treatment plans that are integrated into existing systems of care and related health and human service systems.

(2.6.2)     NAMI urges that service providers, professionals, and others assisting persons with serious mental illnesses who are homeless show them and their families common courtesy, compassion, and respect.

(2.6.3)     When helping to reunite families, NAMI appeals to service providers, professionals, and others assisting persons with serious mental illnesses who are homeless to do what is in the best interest of all concerned, consistent with ethical and medical practices and applicable legal guidelines.

(2.6.4)     NAMI deplores the commonplace use of jails and prisons to warehouse persons with serious mental illnesses who are homeless.

2.7 Persons Infected with the HIV Virus

(2.7.1)     NAMI believes that all persons with serious mental illnesses should be encouraged to be tested for HIV. NAMI believes that persons who test positive should receive appropriate treatment for both their serious mental illnesses and HIV-related illnesses in the least restrictive setting that is safe for all concerned. The results of testing should be shared only on a "need to know" basis and should include families if they are primary caregivers. If families are not primary caregivers, persons with serious mental illnesses should be encouraged to share this information on a voluntary basis.

(2.7.2)     Persons with serious mental illnesses living in institutional settings have been identified as high risks for HIV infection. Therefore, NAMI believes that all persons with serious mental illnesses in institutional settings should be offered HIV testing and strongly encouraged to participate in testing.

(2.7.3)     NAMI urges that education, counseling, and peer support should be made available to the person with a serious mental illness who tests HIV positive and, whenever possible, should be offered to their family and staff as well.

2.8 Children with Serious Mental Illnesses

(2.8.1)      NAMI believes that children and adolescents with serious mental illnesses have the right and must be offered the opportunity to thrive in nurturing environments.

(2.8.2)      NAMI believes that, at the earliest possible time in their lives, all children and adolescents with serious mental illnesses deserve to be diagnosed, appropriately treated, and offered the services necessary to achieve and maintain their recovery.

(2.8.3)      NAMI believes that children and adolescents with serious mental illnesses should be treated in their homes and in their communities whenever that level of treatment is appropriate to their clinical need and they should be offered a full array of demonstratively effective services at that time.

(2.8.4)      NAMI urges parents and caregivers to become well informed about the array of treatments and services that are or should be available in their community. They should be aware of the special education services that are available for the child who may require those services because of a developmental disability (DD) and/or serious mental illness.

(2.8.5)      NAMI calls on all school administrators, teachers, and other education professionals to follow the requirements of the Individuals with Disabilities Education Act (IDEA) in order to ensure that students with serious mental illnesses receive an appropriate education and related services as mandated by the law and to ensure that these students have the opportunity to lead independent and productive adult lives.

(2.8.6)      NAMI calls on federal, state and local education officials to immediately address the low academic achievement and unacceptably high drop-out and failure rates of students in the “emotional disturbance” category of the Individuals with Disabilities Education Act (IDEA). Students living with serious mental illnesses are included in that category.

(2.8.7)      NAMI calls for strong interagency collaboration between all child- and family-serving agencies, including state and local mental health systems; public and private schools; child welfare systems; and juvenile justice systems.

(2.8.8)      When children and adolescents are detained for mental health care or juvenile justice custody due to behavior that might be caused by a serious mental illness, their clinical status must first be evaluated by a qualified mental health professional and must be taken into account before establishing the appropriate conditions for treatment or detention. When detained, children and adolescents with serious mental illnesses must never occupy the same waiting area, living quarters, evaluation and treatment spaces as adults being served in that setting. Girls who are detained should always be supervised by a female attendant.

(2.8.9)      When children and adolescents appear to be experiencing a crisis associated with a serious mental illness, qualified mental health professionals should always be among the first responders contacted. Families should not be directed to law enforcement when a child is experiencing a psychiatric crisis at home or in the community. Every community must have access to an effective and appropriate crisis response system for children and adolescents with serious mental illnesses.

(2.8.10)    Schools should not call law enforcement as the first responder in a psychiatric crisis. The intervention of law enforcement personnel either in schools or the community should always be a last resort and should only occur when it is the only option to protect the child and/or the public. School personnel should be trained to effectively de-escalate a psychiatric crisis and schools should have appropriate links to crisis services in the community mental health system.

(2.8.11)     In the event that a child exhibits or threatens aggression or self-injurious behavior during a crisis and transportation to a treatment facility is necessary, a qualified mental health professional and/or appropriately trained law enforcement officer must first de-escalate the crisis and then arrange for transportation, preferably in a family vehicle if appropriate or in the least threatening and stigmatizing vehicle available. Adult family members, caregivers, persons known to and trusted by the child, or qualified mental health service providers should accompany the child in transit. When being transported for psychiatric evaluation, psychiatric care or juvenile detention related to a mental health issue, children and adolescents should never occupy the same vehicle or detention areas as adults. Girls who are being transported should always be supervised by female attendants. Using the appropriate vehicle and ensuring appropriate conditions for transportation, during psychiatric crisis, can avoid re-traumatizing the child, the adolescent and the family.

(2.8.12)     NAMI believes that families should never be coerced to relinquish custody of their dependent children with serious mental illnesses in order to obtain care, treatment, on an education. The health care service system must be restructured to ensure that children and families are never forced to seek mental health services in the child welfare and juvenile justice systems.

(2.8.13)     NAMI recognizes the critical role that families play in the recovery and development of their children. Therefore NAMI supports the right of families of children who have serious mental illnesses to visit and otherwise maintain as normal contact as appropriate with their children when they are being served in hospitals and other residential facilities. These facilities must not impose overly restrictive visitation limits that prohibit families from visiting their child.

(2.8.14)     NAMI calls on national, state and local leaders to take immediate action to end the workforce shortage in children’s mental health services.

(2.8.15)     NAMI believes that all primary care providers, including pediatricians, family practice physicians, and advanced practice nurses must be trained to recognize the early warning signs of serious mental illnesses in children, to provide effective treatment as necessary and to develop collaborative agreements with child psychiatrists to whom they can refer children and families for specialized services.

2.9 Minor Children of Parents with Serious Mental Illnesses

NAMI recommends that NIMH study the special problems of minor children whose parents have serious mental illnesses. The diagnosis of a serious mental illness alone is not sufficient grounds for losing custody of one's children.

2. Priority and Special Population

Join NAMI today!